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UNITED STATES OF AMERICA. 



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PRACTICAL URINE TESTING: 



A GUIDE 



TO OFFICE AND BEDSIDE URINE ANALYSIS 
FOR PHYSICIANS AND STUDENTS. 



BY 

CHARLES GODWIN JEOINGS, M. D. 

PROFESSOR OF CHEMISTRY AND OF DISEASES OF CHILDREN 
DETROIT COLLEGE OF MEDICINE, ETC. 




DETROIT: 
D. O. HAYNES & COMPANY 

1887. 



• ^V 



Copyright, 1887, by 
D. O. HAYNES & CO 



PREFACE. 



The importance of urine testing at the bed- 
side for the immediate detection of pathological 
conditions and for watching the progress of 
disease is now recognized, and reagents for the 
detection of sugar, albumin, etc., form a necessary 
part of a physician's armamentarium. The recent 
investigations in this department of chemistry 
have brought forward convenient and accurate 
methods of urine analysis which enable the phy- 
sician to obtain in a minimum of time all the 
information which is of any value to him. It is 
the aim of this little volume to give concise 
directions for office and bedside testing, embody- 
ing all the latest advances that have proved to be 
of value. 

Particular attention has been given to the 
qualitative and quantitative tests which from 
their cleanliness and ease of application, and the 
simplicity of apparatus required, commend them- 
selves to the practicing physician. 

Part I is devoted to a brief consideration of 
the chemistry of the urine in health and disease, 



1V PREFACE. 

and concisely discusses the relative utility of 
various methods of testing for normal and patho- 
logical ingredients. 

Part II presents a systematic scheme for urine 
analysis unencumbered by physiological or patho- 
logical data ; a chapter on the microscopical exam- 
ination, one on the analysis of calculi, and one 
on apparatus and reagents. 

Much of the subject matter has been compiled 
from various sources, but the author has con- 
densed and arranged it in a manner which, in his 
judgment, is best suited to the purpose in view. 

It was thought not best to burden the text 
with too many references ; in addition to those 
given, the author acknowledges indebtedness 
especially to Charles' " Physiological and Patho- 
logical Chemistry," Witthaus' « Manual,' 1 Ealfe's 
"Clinical Chemistry," Oliver's "Bedside Urine 
Testing," and Tyson's "Practical Examination 
of Urine." 

544 Jefferson ave., May, 1S87. 



TABLE OF CONTENTS. 



PART I. 

Physiology and Pathology of the Urine. 

Chapter I. —Physical Characters. 

Quantity — Color — Odor — Transparency — Specific Grav- 
ity — Reaction, Acid Fermentation, Alkaline Fer- 
mentation — Consistence Page 9 

Chapter II. — Normal Constituents. 

Urea — Uric Acid — Urine Pigments — Hippuric Acid — 
Chlorides— Phosphates— Sulphates Page 17 

Chapter III.— Abnormal Constituents. 

Proteids — Serum Albumin, Classification of Albumin- 
urias— Serum Globulin — Albuminates — Peptones — 
Fibrin — Glucose — Inosite — Lactose — Acetone — 
Blood— Bile— Leucin and Tyrosin — Fat Page 22 

PART II. 

Practical Urine Analysis. 

Chapter I. — Qualitative Analysis. 

Determination of General Properties — Specific Gravity 
— Reaction — Tests for Proteids— Tests for Serum 
Albumin — Tests for Peptone — Tests for Serum 
Globulin — Test for Mucin— Tests for Glucose- 
Test for Indican — Tests for Blood — Tests for Bile, 
Bile Pigment, Bile Salts— Test for Chlorides— Test 
for Phosphates — Test for Sulphates — Tests for 
Acetone Page 53 



Yl TABLE OF CONTENTS. 

Chapter II.— Quantitative Analysis. 

Estimation of Total Urinary Solids — Estimation of 
Uric Acid — Estimation of Chlorides — Estimation 
of Phosphates — Estimation of Albumin — Estima- 
tion of Glucose— Estimation of Bile Salts Page 67 

Chapter III. —Microscopical Examination. 

General Directions — Classification of Deposits — Uric 
Acid — Urates — Calcium Oxalate — Phosphates — 
Cystin — Oil Globules— Epithelium — Mucus and 
Pus — Blood — Tube Casts— Spermatozoa — Microbes 
— Elements of Morbid Growths Page 91 

Chapter IV. — Analysis of Calculi. 

General Properties of Calculi — Scheme for Analysis. . . 

Page US 

Chapter V. — Apparatus and Reagents. 

Apparatus — General Reagents— Special Reagents for 
Albumin Testing — Special Reagent for Bile Salt 
Testing — Miscellaneous Reagents — Tablets and 
Test Papers Page 115 

Addenda Page 123 



PART I. 

Physiology and Pathology of the Urine 



CHAPTER I. 



PHYSICAL CHARACTERS. 

Quantity. The average healthy adult man 
passes from 35 to 50 ozs. (1000—1500 cc.) in 24 
hours. The adult woman from 30 to 40 ozs. 
(900 to 1200 cc.) 
The quantity is increased — 
Physiologically by — 

Increase of general blood pressure ; 
Increase of the pressure within area of renal 

artery ; 
Copious drinking ; 

Contraction of the cutaneous vessels ; 
The action of diuretic foods and drugs. 
Pathologically — 

In diabetes insipidus and mellitus ; 
In granular kidney with cardiac hypertro- 
phy ; 
In the early stages of waxy kidney ; 
After the absorption of cedematous fluids or 

exudates ; 
In convalescence from fevers ; 
In hysteria, chorea and epilepsy. 
The quantity is diminished— 
Physiologically by — 

Decrease of general or local blood pressure ; 
Profuse sweating ; 
ISTon-nitrogenous food. 

2 






10 PHYSICAL CHARACTERS. 

Pathologically in — 

Weakened heart action ; 
Active and passive congestion of the kid- 
neys ; 
All acute inflammatory diseases and fevers ; 
Diarrhoea, enteritis and cholera ; 
Mechanical compression or closure of ureters; 
The last stage of all forms of Bright's dis- 
ease ; 
Cirrhosis of the liver. 
Transient variations in quantity are of little 
significance ; persistent variations always demand 
investigation. 

Color. Normal urine varies from a pale 
straw color to a deep amber. The color is 
changed— 

Physiologically by — 

Variations in concentration ; 

The ingestion of certain foods and drugs. 
(Rhubarb, logwood, indigo, madder, etc., 
their distinctive color; santonin, yellow, 
bile-like color; carbolic acid and creo- 
sote, olive green.) 
Pathologically it is paled by — 

Hysteria and other paroxysmal nervous dis- 
eases ; 

Diabetes mellitus and insipidus; 

Chronic Bright's disease ; 

Convalescence from acute diseases. 
It is darkened by — 

Disorders of the liver ; 

Fevers and acute inflammatory diseases ; 

Diarrhoeal disorders ; 

Admixture with blood (according to the de- 
gree of decomposition of the hsemoglo- 



PHYSICAL CHARACTERS. 11 

bin it is red, dark brownish-red or 
smoky); 
Bile-pigments (deep, yellowish-brown with 
intense yellow froth). 

Odor. The characteristic not unpleasant 
odor of normal, freshly-passed urine is well 
known. Concentrated urines have a strong odor. 
Old urines develop a putrescent and ammoniacal 
odor. In newly-passed urine this is indicative of 
chronic organic disease of the urinary tract. 
Yarious drugs and articles of food, e. g., turpen- 
tine, asparagus, impart peculiar odors to healthy 
urine. 

Transparency* Perfectly normal urine 
is clear when passed, although slight disturbances 
of the chemistry of the body, not manifested by 
symptoms, may give rise to some turbidity due 
to earthy phosphates or mixed urates. Many 
pathological urines are perfectly clear. 
Pathological turbidity may be due to — 

Urates ; 

Phosphates ; 

Pus; 

Mucus ; 

Chylous urine ; 

Granular and fatty debris of epithelium in 
Bright's disease ; 

Blood. 

Specific gravity. The average specific 
gravity of normal urine is about 1020. It varies 
much within physiological limits. As the spe- 
cific gravity depends upon the proportion of 
water to the dissolved solids, conditions that dis- 
turb these relations affect the specific gravity 



12 PHYSICAL CHARACTERS. 

A health}^ man of average weight, 140 pounds, 
should excrete about 50 ozs. (1500 cc.) of urine 
in 24 hours, of a specific gravity of 1020. This 
urine will contain 4 per cent, of solid matter, or 
about 20 grains to the ounce, or 1000 grains in 
24 hours. 

From the specific gravity an approximate 
quantitative estimation of the urinary solids may 
be made. In general, the amount of total solids 
is a measure, (1) of the activity of tissue change ; 
(2) of renal integrity ; (3) of abnormal constitu- 
ents in the urine. Estimation of solids from the 
specific gravity is a ready method of obtaining 
important information. 

Hygienic conditions favoring increased meta- 
bolism, as abundant food, active exercise, etc., 
increase, and the opposite conditions decrease the 
solid matter in the urine. 

Pathologically the urinary solids are defi- 
cient— 

(1) With the urine normal or sub-normal in 
amount — 

(a) YYom.de/ective and enfeebled metabolism, 

as — 
Senility ; 
Ansemia; 

The cachexias of syphilis, cancer, etc. ; 
Chronic alcoholism ; 
Functional or organic diseases of the 
liver. 

(b) From renal failure, as in — 
j Acute nephritis ; 

Acute exacerbations of chronic renal 

disease ; 
The close of Bright's disease ; 



PHYSICAL CHARACTERS. 13 

The early stage of Bright's disease 

(sometimes) ; 
Venous congestion of the kidneys (car- 
diac disease, etc.). 
(2) With the urine increased in amount — 
In diabetes insipidus ; 
Interstitial nephritis (often) ; 
Amyloid disease of the kidney (often) ; 
Chronic parenchymatous nephritis. 
The urinary solids are increased — 
(1) With the quantity not inci'eased in — 
Fevers ; 
Lithsemia ; 

Some forms of dyspepsia. 
(3) With the quantity increased in — 
Diabetes ; 

Phosphaturia (phosphatic diabetes) ; 
Azoturia (excessive secretion of urea). 
The urinometer is generally used to determine 
the specific gravity. A specific gravity bead, 
however, made to float at 1.005 offers many ad- 
vantages over it. The bead is cheap, portable, 
not easily broken, and with it the specific grav- 
ity of very small quantities of urine may be 
taken. The bead must be very carefully tested, 
as any inaccuracies are magnified by the dilution 
of the urine that is necessary. 

Reaction, The reaction of fresh normal 
urine is usually acid. Some urines show what is 
termed the amphoteric reaction, that is, give both 
the acid and alkaline reaction to test paper. The 
acidity is due to the presence of acid sodium 
phosphate, NaH 2 P0 4 , and also, perhaps, to some 
extent to minute quantities of free carbonic, uric 
and hippuric acids. It must be admitted, how- 



14 PHYSICAL CHARACTERS. 

ever, that little or no free acid can be detected by 
sodium hyposulphite. The amount of acidity in 
the total urine of 24 hours is equivalent to 30 to 
60 grains (2 to 4 grams) of oxalic acid. 

Physiologically there is increased acid- 
ity- 

During the night ; 

With a flesh diet ; 

After strong muscular exertion ; 

During the intervals of gastric digestion ; 

After the ingestion of mineral acids. 
Pathologically — 

In fevers ; 

In rheumatism ; 

After asthmatic attacks ; 

In emphysema, pneumonia, pleuritis. 
Physiologically the urine is less acid or 
alkaline— 

During gastric digestion ; 

After hot or prolonged cold baths ; 

After profuse sweating ; 

After copious ingestion of vegetable acids 
and their salts. 
Pathologically — 

In acute and chronic inflammation of the 
urinary tract, as cystitis, pyalitis ; 

In decomposition of the urine in the bladder 
in retention ; 

In some cerebral and nervous diseases ; 

In anaemia, chlorosis, general debility. 

Acid fermentation. When urine is set 
aside in a cool place it gradually becomes more 
acid. This is called the acid fermentation. To 
what it is due ie a matter of dispute. Landois 
and Sterling think it results from the develop- 
ment of a special microbe. The process is ac- 



PHYSICAL CHARACTERS. 15 

com pained by the deposition of uric acid, acid 
sodium urate and calcium oxalate. The fungus 
and the bladder mucus decompose part of the 
urine pigment into lactic and acetic acids, and 
the latter sets free uric acid from neutral sodium 
urate ; a part of the neutral sodium urate is 
changed to the acid urate. 

Alkaline fermentation. After long- 
er exposure to a warm atmosphere the urine be- 
comes neutral, and finally strongly alkaline in 
reaction. It becomes turbid, has an ammoniacal 
odor, and deposits triple phosphate, ammonium 
urate and great numbers of microbes. An irri- 
descent film containing triple phosphate crystals 
covers its surface. This alkaline fermentation 
is due to the transformation of the urea into am- 
monia and carbon di-oxide CO(NH 2 ) 2 + H 2 0=: 
2NH 3 + C0 2 under the influence of a microbe 
which appears in the form of free globules, of 
articulated filaments or of chaplets. It has re- 
ceived the name of micrococcus ureo3. This fer- 
ment is conveyed through the air, like other 
microbes of fermentation. So long as the urine 
remains acid it does not exist in the bladder. It, 
however, is common around the orifice of the 
urethra, and sometimes gains entrance to the 
bladder through the medium of a sound or cathe- 
ter. Experiments have shown this microbe to be 
the true cause of the ammoniacal fermentation of 
the urine. Sternberg has demonstrated that only 
the microbes of the air or those about the ureth- 
ral orifice can produce it. Urine guarded against 
the introduction of these organisms may be pre- 
served in a sterilized vessel for an indefinite time 
without undergoing any change. 



16 PHYSICAL CHARACTERS. 

Consistence. Normal urine is perfectly 
aqueous. 

Pathologically it may be thick or glutinous 
from — 

Mucus ; 

Decomposed pus ; 
Molecular fat (cliyluria). 



OHAPTEE II, 



NORMAL CONSTITUENTS. 

Urea. (C O E 2 H 4 .) Urea is the principal 
constituent of the urine, this fluid containing 
from 2 to 4 per cent., or an average mean of 2.5 
to 3.2 per cent. It forms nearly one-half the 
total solids of the urine. 

It is the end product in the decomposition of 
the proteids forming the tissues of the body and 
ingested in the food. The change takes place in 
the liver, spleen and tissues generally. Accord- 
ing to Oliver, urea is chiefly formed by the dis- 
integration of the red blood cells in the liver. 
The mean amount excreted in 24 hours by a 
health} 7 man is 525 grains (35 grams) ; by a 
woman 385 grains (25 grams). The amount 
varies greatly within the limits of health. 

Physiologically the urea is increased by — 

Large eating ; nitrogenous food ; 

Copious ingestion of water ; 

Exercise and muscular vigor. 
It is decreased by- 
Fasting or spare feeding ; 

Eon-nitrogenous food ; 

Reduction of water in the diet ; 

Alcoholic beverages, tea or coffee ; 

Indolence of mind and body. 
Pathologically the urea varies with the total 
solids. In disease the activity of metabolism 
and the integrity of the kidneys may be deter- 



18 NORMAL CONSTITUENTS. 

mined by the quantitative estimation of the urea. 
For ordinary clinical work the specific gravity 
may be utilized for this purpose, and it gives 
fairly approximate results. Often, however, it 
may be of great value to determine the amount 
by a more accurate method. 

Uric Acid. (C 5 H 4 N" 4 3 .) This body occurs 
free in normal urine only in the most minute 
quantity (soluble in 18000 parts of cold, and 
15000 parts of boiling water). From 7 to 10 
grains (.5 to .7 grams) are excreted daily in^the 
form of acid urates of sodium and potassium. It 
is a less oxidized metabolic product than urea, 
but it is not proven that it is a precursor of urea. 
Physiologically it is increased and di« 
minished. pari passu with urea. 
Pathologically it is increased by — 
Indigestion ; 

Acute dropsies, rheumatic and catarrhal in- 
flammations ; 
After attacks of gout ; 
In cancer of the liver (Harley) ; 
In leukaemia ; 

All disturbances of the circulation and res- 
piration. 
It is decreased— 
In chronic maladies in general ; 
Diabetes and polyuria ; 
Before paroxysms of gout, and during 

chronic gout ; 
Anaemias ; 

Chronic rheumatism ; 
Chronic disease of spinal cord. 

Urine Pigments. What the urinary 
pigments are is still a subject of controversy. 



NORMAL CONSTITUENTS. 19 

Urobilin (hydrobilirubin) is the chief urinary 
pigment. The red blood corpuscles are decom- 
posed in the liver into bile pigment and urea. 
Bile pigment is converted in the small intestines 
by the action of free hydrogen into urobiline, a 
small portion of which is absorbed and excreted 
in the urine. Conditions that increase the de- 
struction of red blood corpuscles, therefore, in- 
crease the intensity of the color of the urine. 
Chemical tests for variations in the quantity of 
this body are imperfect, and for clinical purposes 
valueless. 

Urine Indican. (Uroxanthin.) C 52 H 62 1ST 2 34 . 
The presence of this pigmentary body is fairly 
well determined. It is colorless, but is trans- 
formed into indigo blue by various reagents. It 
is present in but small quantity in normal urine, 
but subject to much variation. 

The pathological significance of increase has 
not yet been fairly determined. It has been 
found to be decreased in 

Derangements of the nervous system ; 

During reaction from cholera? 

Cancer of the stomach and abdomen ; 

Addison's disease ; 

Cirrhosis of the liver ; 

All diseases attended by intestinal obstruc- 
tion : 

Some forms of diarrhoea ; 

Typhoid fever, peritonitis, phthisis. 

Hippuric Acid, kreatinine, phenol-sul- 
phuric acid and some other complex organic 
compounds are more or less constant constituents 
of normal and pathological urine, but they are of 
interest only to the physiologist. 



20 NORMAL CONSTITUENTS. 

INORGANIC CONSTITUENTS. 

These chiefly consist of sodium, potassium, 
ammonium, calcium, magnesium and iron, com- 
bined with hydrochloric, phosphoric and sulphu- 
ric acids. The determination of the presence 
and amount of these substances is often of physi- 
ological interest, and may sometimes furnish 
valuable evidence of disease and its progress. 
In ordinary examinations of urine, however, their 
determination may be omitted. 

Chlorides. Next to urea the chlorides 
form the chief portion of the urinary solids. 
Sodium chloride is by far the most abundant. 
Daily 150 to 185 grains (9.7 to 12 grams) are 
excreted. 

The chlorides are increased physiologic- 
ally — 

After the ingestion of salt foods and much 

water ; 
Mental and physical activity ; 
During pregnancy ; and, 
Pathologically — 

After the crises of fevers ; 
After the absorption of exudates ; 
In diabetes (occasionally). 
The chlorides are decreased pathologic- 
ally — 

In all acute fevers ; 

Pneumonia (often entirely absent during 

hight of disease) ; 
In cholera ; 

In most chronic diseases. 
An increase, or the re-establishment of the ex- 
cretion of chlorides in disease is generally a 



NORMAL CONSTITUENTS. 21 

favorable sign. In pneumonia it is a precursor 
of the crisis, and ma} 7 often take place before 
other symptoms reveal the favorable change. 

Phosphates. Phosphoric acid occurs in 
the urine combined with sodium and potassium 
{alkaline phosphates) and calcium and magnesium 
{earthy phosphates). From 70 to 90 grains (4.7 to 
5.8 grams) are excreted in 34 hours. 

Physiologically variations in the amount are 
caused chiefly by the character of the food. 

Pathologically the phosphates are in- 
creased— 
In rickets ; 
Osteomalacia ; 
Chronic rheumatism ; 
Diseases of the nerve centers ; 
After great mental strain and worry. 

Sulphates. Sulphates of sodium and po- 
tassium are excreted in the urine, the quantity 
varying from 45 to 60 grains (3. to 4. grams). 

Physiologically, the sulphates are in- 
creased— 

By the ingestion of sulphur and its com- 
pounds ; 
Nitrogenous food ; 
Conditions of increased metabolism. 



CHAPTER in. 



ABNORMAL CONSTITUENTS. 
PROTEIDS. 

The proteids found in the urine under various 
conditions are serum albumin, globulin, albu- 
minates, peptones, jib?*in and mucin. 

Serum Albumin. Albuminuria is a symp- 
tom of many pathological conditions, and occa- 
sionally occurs in persons apparently healthy. 

Amount. The amount of albumin in patho- 
logical urine varies from ^ per cent, or less to 
24 or 3 per cent. It may rise to 4 per cent. 
The average amount is T V to •§- per cent. In 
24 hours 60 to 150 grains (4 to 10 grams) are 
ordinarily excreted. The amount may be so 
high as 400 grains (26 grams). 

Functional Albuminuria. By delicate test- 
ing minute traces of albumin may at times be 
demonstrated in the urine of a majority of 
healthy persons. Chateaubourg of Paris found 
traces of albumin in the urine of 321 soldiers out 
of 423 examined. Of 142 healthy children the 
urine of 111 contained albumin. The observa- 
tions of Senator and Laube in Germany, of Oli- 
ver in England, and Purdy in this country, show 
similar results. My own experience, also, is the 
same. 

Probably no individual ever lives for any 
length of time with the body in a perfectly 



ABNORMAL CONSTITUENTS. 23 

physiological condition — with every function 
perfectly performed ; with waste and repair, in- 
gestion and exercise, assimilation and excretion 
perfectly balanced. The vicissitudes of cli- 
mate and weather, diatetic errors, slight di- 
gestive disturbances, mental and muscular exer- 
tions, to which the average man is constantly 
exposed, are sufficient to determine the imperfec- 
tions in the delicate chemistry of nutrition that 
give rise to this symptom. It is very necessary 
for the observer to be familiar with the reaction 
which the urine of healthy persons will some- 
times give, and he should carefully note it in a 
series of specimens. The most sensitive tests are 
necessary, as heat after acid ulation, picric acid or 
potassio-mercuric iodide, and the most delicate 
manipulation. 

Albumin in easily recognizable quantity is not in- 
frequently found in the urine, especially of young 
adults, without there being any attendant great 
disturbance of bodily health or recognizable 
renal disease. Many of these individuals appear 
perfectly healthy, others are angemic or suffering 
from some constitutional taint, as syphilis, scrof- 
ula, rheumatism, etc. This condition has been 
described by various writers as " intermittent 
albuminuria," " cyclical albuminuria," " albumin- 
uria of digestion," " albuminuria of adolescents," 
etc., and has recently attracted considerable atten- 
tion. A careful study of these non-dangerous 
albuminurias is important. 

The conditions which have been found to be 
attended by this symptom are — 

Severe muscular exercise, or any exercise. 



24 ABNORMAL CONSTITUENTS. 

Errors in diet, diet rich in proteids, or sim- 
ply the ingestion of any food (dietetic 
albuminuria). 
Mental emotion, exercise or worry. 
The albuminuria maybe paroxysmal, intermit- 
tent, remittent or, more rarely, persistent. The 
quantity of albumin discharged is small, ^ to -^ 
per cent, or less. The urine is dark colored, of 
normal or high specific gravity, contains the nor- 
mal or an excessive quantity of urea, and the bile 
salts are usually increased. Casts are absent. 

Opinions differ as to the conditions which im- 
mediately give rise to this form of albuminuria. 
They may be — 

Dilatation of the vessels in the renal area; 
The formation of more diffusible proteids 

during digestion ; 
Excess of saline constituents in the blood ; 
Increased haemolysis ; 

A combination of two or more of these con- 
ditions. 
Dr. C. H. Ralfe believes all functional albu- 
minurias to have one etiological factor, namely, 
abnormally increased haemolysis, and he considers 
functional albuminuria and hemoglobinuria to 
be intimately related — the albuminuria being 
simply a minor manifestation of hemoglobinu- 
ria. In health the effete hemoglobin is decom- 
posed in the liver into pigment and urea. In 
disease the hemolytic action is so increased that 
some of the albumin or hemoglobin escapes 
transformation, passes into the general circula- 
tion and is excreted by the kidneys. 

Ralfe* expresses the gradations of hemolytic 
action and their results thus : 

* London Lancet, Am. Reprint, Dec., 1886. 



ABNORMAL CONSTITUENTS. 25 

0rdi Sol JS is, j Sr T PigmCnt ' f Nc-l urine. 

Acti ™ i In S™L? f urinary I Urine of 

hemolysis. h^faTofurea. | di g e9tion 



f Increase of urinary 
pigment, 
Increased J Appearance of bile 



Functional 



haemolysis, ) pigment, albuminuria. 

Increase of urea, 
[ Albumin in urine. J 

("Haemoglobin in "] 
urine, 

Extraordinary j Increase of urinary I „_ ^„i^i ,• :„ 

haemolysis, ] and bile pigment, \ Hemoglobinuria. 
j Increase of urea, 
^ Albumin in urine. J 

As causes of the increased haemolysis he sug- 
gests increased irritability of the vaso-motor re- 
flex center and the formation, probably owing to 
disorder of the blood-forming organs, of corpus- 
cles unable to withstand unusual disintegrating 
influences. 

Classification or Albuminurias. 

(1) Renal affections. The kidneys have un- 
dergone structural change, and the albumin filters 
into the urine because of inflammatory and de- 
generative changes in the epithelium of the Mal- 
pighian capsules and the tubes. The changes in 
the inflammatory and specific fevers are vaso- 
motor paralysis, mild tubular catarrh, swelling 
and proliferation of the epithelium. 

(a) Diseases primarily affecting the kidneys — 
Acute congestion (a chill, action of medici- 
nal irritant) ; 
Acute nephritis ; 



26 ABNORMAL CONSTITUENTS. 

The different forms of chronic Bright's dis- 
ease ; 
Renal (tubular) concretions, 
(b) Diseases secondarily affecting the kidneys — 
Retention of urine from obstructed ureters ; 
Last stage of diabetes ; 
The exanthemata ; 
Diphtheria ; 

Typhus and typhoid fevers ; 
Cholera ; 
Pyaemia ; 
Pneumonia ; 
Peritonitis. 

(2) Disturbed renal circulation from extra- 
renal cause — reduction or increase of blood pres- 
sure. Whether the blood pressure is increased 
or diminished is often difficult to determine. 
The renal epithelium remains healthy. 

Compression of renal arteries or veins by 

tumors, etc. ; 
Pregnancy and other abdominal tumors ; 
Compression of aorta above renal vessels ; 
Diseases of the heart ; 
Cirrhosis of the liver ; 
Pleuritic effusion ; 

Chronic bronchitis, pneumonia, phthisis ; 
Great reduction of temperature ; 
Epilepsy, tetanus, lead colic. 

(3) Disturbed innervation. The albuminuria 
is caused by changes in the diameter of the blood 
vessels, and sometimes perhaps by trophic 
changes in the renal epithelium. 

Organic lesions of different parts of brain 

and spinal cord ; 
Mental strain and worry ; 
Exophthalmic goitre ; 



ABNORMAL CONSTITUENTS. 27 

Delirium tremens ; 
Cerebral hemorrhage. 

(4) Alterations in the constitution of the blood. 
The diminished blood pressure and degenerative 
changes in the epithelium permit the filtration of 
albumin into the urine. 

Anaemia, chlorosis ; 
Scurvy, purpura ; 
Gout ; 
Syphilis ; 
Tuberculosis ; 
Poisoning. 

(5) Admixture with albuminous fluids, as — 
Blood ; 

Pus; 

Semen ; 

Vaginal secretions. 
Many times a combination of two or more of 
the above general conditions are present. In 
acute nephritis, for example, destruction of renal 
epithelium, disturbed circulation and admixture 
with blood all contribute to the albuminuria. 

Tests for Albumin in the order of their 
delicacy. 

Potassio-mercuric iodide. Tanret's 
reagent. May be used in solution, tablet or test 
paper. 

Bodies precipitated. Albumin, globulin, albu- 
minates, peptones, alkaloids, mucin. 

Delicacy. Detects 1 part albumin in 20.000. 

Precautions. When a reaction occurs the 
solution must be heated. Peptones, urates, alka- 
loids and mucin dissolve. When the reagent is 
used in solution a mucin reaction sometimes 
occurs that closely simulates albumin, the concen- 



28 ABNORMAL CONSTITUENTS. 

trated reagent and acid preventing the solution of 
the precipitate by heat. According to Dr. Oliver 
this source of fallacy may be avoided by using 
the reagent in the form of test paper. The test 
paper or tablet is dissolved in 60 minims (4 cc.) 
of water in a test tube and 15 minims (1 cc.) of 
the urine added. The faint precipitate of mucin 
is redissolved by heat. The behavior of this rea- 
gent with mucin and other urine constituents 
should be very carefully studied before it is used 
as an albumin test. 

Remarks. This reagent detects the most mi- 
nute traces of albumin. Many urines of healthy 
persons give a reaction. This delicacy makes 
the reagent a very valuable one, but it must be 
used with caution, and its indications must 
be confirmed by other tests. Its great value 
is as a general test for proteids and as a rea- 
gent to quickly and certainly exclude albumin. 
A urine that gives no precipitate with potas- 
sio-mercuric iodide, or one that dissolves by 
heat, is absolutely albumin-free ; further testing 
is superfluous. The faint opacity which many 
healthy urines give will never, after a little obser- 
vation, be mistaken for pathological albuminuria. 
The very fact that it precipitates so many bodies 
is a source of security rather than weakness. 
The observer will find so many urines that give a 
precipitate with this reagent which clears up by 
heat that he will soon mechanically correct it. A 
reagent with a source of occasional error, like 
heat, is a much more dangerous one. 

Sodium Tung'state. Used in saturated 
solution, tablet or test paper with citric acid. It 
may be used by the contact method. 



ABNORMAL CONSTITUENTS. 29 

Bodies precipitated. Serum albumin, globu- 
lin, albuminates, peptones. 

Delicacy. Detects 1 part albumin in 20.000. 

Precautions. When reaction occurs solution 
must be heated. Peptones dissolve. 

Remarks. It will be noted that alkaloids are 
not thrown down by this reagent, and it thus 
serves to distinguish between peptones and alka- 
loids. The solution is clear, and it is a very deli- 
cate and reliable test. 

Picric Acid. Advocated by Dr. George 
Johnson. Used in saturated solution, powder, 
tablet or test paper without acidulation. 

Bodies precipitated. Serum albumin, globu- 
lin, albuminates, peptones, alkaloids. After 
some time (crystalline) uric acid and kreatinine. 

Delicacy. Detects 1 part albumin in 20.000. 

Precautions. The reagent must always be 
used in excess. When reaction occurs boil the 
solution ; peptones and alkaloids dissolve. 

Remarks. A very delicate and reliable test. 
It is particularly valuable as a pocket reagent, as 
it is also an excellent test for glucose. The in- 
tense yellow color may prove to some a slight 
hindrance to the detection of minute quantities 
of albumin. 

Heat. A temperature of from 164° F. to 
167° F. coagulates serum albumin. The most 
delicate and reliable method of use is to acidify 
a 3 or 4 inch column of urine by a drop of acetic 
acid and heat the upper half. By comparison 
with the lower clear portion the slightest haze 
may be detected. 

Bodies precipitated. Serum albumin, globu- 
lin, earthy phosphates. 



30 ABNORMAL CONSTITUENTS. 

Delicacy. When carefully applied it Las 
almost the delicacy of the above tests. 

Precautions. The precipitation of the earthy 
phosphates is ordinarily prevented by the acidu- 
lation, but to certainly exclude this source of 
error a drop or two of nitric acid must be added 
after boiling. Any remaining precipitate or 
opacity is albumin. Care in acidulation is abso-, 
lutely necessary. The native albumins are readily 
converted by the slow action of acids and alkalies 
into albuminates, which do not precipitate by heat. 
Albumin in this state, even when present in large 
quantity, may escape detection by the heat test. 
The reaction of the urine will be the guide to the 
amount of acid necessary. Many highly acid 
urines, as those that deposit urates or uric acid, 
require no previous acidification, while a highly 
alkaline one may require 3 or 4 drops of acetic 
acid. This point demands judgment and some 
experience. 

Remarlis. The heat test is, perhaps, the most 
frequently used of all the albumin detecting 
methods. It is open to the objection that the 
greatest care is necessary to exclude occasional 
erroneous results. It should never be alone re- 
lied upon. As peptones and albuminates escape 
detection by heat, it cannot be used as a general 
test for proteids. 

Pota§§iuan Ferrocyanicle. Used in 
saturated solution, tablet or test paper with acetic 
or citric acid. 

Bodies precipitated. Serum albumin, globu- 
lin, albuminates; very rarely urates (Oliver). I 
have as yet never seen this reagent precipitate 
urates even with concentrated solutions. 



ABNORMAL CONSTITUENTS. 31 

Delicacy. Detects 1 part albumin in 10.000 
(Oliver). 

Precautions. This reagent must be used cold. 
Boiling decomposes the ferrocyanide with the 
formation of a white precipitate. 

Remarks. It will be noted that this reagent 
does not precipitate alkaloids or peptones. It is 
almost entirely free from sources of error, does 
not require boiling for correction, is portable, 
and not too delicate. It therefore forms one of 
the readiest applied and most reliable albumin 
reagents. If the physician wishes to use but one 
test in his routine work this one should be select- 
ed. The reaction takes place rather slowly, and 
my own experience does not give it a much 
greater delicacy than nitric acid. 

Acidulated Brine, Introduced by Dr. 
Koberts of England. It may be applied by the 
contact method. 

Bodtes precipitated. Serum albumin, globu- 
lin, albuminates, peptones, urates. 

Delicacy. Detects 1 part albumin in about 
8.000. 

Precautions. The solution must be heated. 
Peptones and urates dissolve. 

Remarks. I have found this to be a most sat- 
isfactory test. The solution is colorless, and 
does not give a color reaction like nitric acid to 
obscure a delicate ring. 

Nitric Acid. This reagent should be used 
only by the contact or Heller's method (page 58). 
The simple addition of nitric acid to urine is 
coarse and inaccurate. 

Bodies precipitated. Serum albumin, globu- 



32 ABNORMAL CONSTITUENTS. 

lin, albuminates. Rarely oleo-resins, urates and 
excess of urea give a hazy ring. 

Delieacy. Detects about 1 part of albumin in 
6000. 

Precautions. Sometimes oleo-resins, urates 
and urea give a ring as above noted, but it 
is diffuse, situated above the point of contact, and 
is readily dissipated by heat. Urines containing 
these substances with albumin give two rings — 
the sharply defined albumin ring at the point of 
contact and the hazy ring above it. 

Remarks. Although within its limits nitric 
acid is a very reliable test, it is an intensely cor- 
rosive agent, there are other equally reliable, 
cleanly and portable tests of about the same range 
of albumin detecting power that can replace 
nitric acid. I never use it except for purposes 
of comparison and study. 

Globulin. Serum globulin is found in the 
urine along with serum albumin in some forms 
of renal disease. Werner reports a case of ne- 
phritis in which it was the only proteid found. 

It is thrown down by heat and all the other 
albumin precipitants. It differs from serum albu- 
min in being insoluble in water. It is readily 
converted into albuminates. It is soluble in saline 
solutions, and is thus held in solution in the urine. 
When present it may be detected by adding 
water to the urine until it has a specific gravity 
of 1002 or 1003 ; the globulin forms a cloudy 
precipitate. 

It has been found in the urine in — 

Vesical catarrh ; 

Acute nephritis (early stage) ; 

Advanced chronic renal disease ; 

Waxy kidney (most abundant). 



ABNORMAL CONSTITUENTS. 33 

Albuminates. Serum albumin, and par- 
ticularly globulin, when subjected to the action 
of acids or alkalis, are transformed into albumin- 
ates or derived albumins. They may be regard- 
ed as acid and alkali combinations of neutraliza- 
tion precipitates. Solutions of albuminates pre- 
cipitate by neutralization but not by heat. Con- 
ditions favoring the formation of albuminates 
are found when the urine is alkaline, or when an 
excess of acid has been added to acidify. Care- 
ful neutralization of a urine containing one of 
these bodies causes a precipitate. These import- 
ant modifications of albumin may always be de- 
tected by the use of potassio-mercuric iodide, 
sodium tungstate, potassium ferrocyanide, etc., as 
albumin tests. 

Peptones. These products of the digestion 
of proteids occur not infrequently in the urine in 
disease. Their presence is always a pathological 
occurrence. A number of peptones have been 
identified, representing successive steps in the 
gastric and pancreatic digestion of albumin. 
Whether one or more of these find their way 
into pathological urine has not yet been deter- 
mined. 

A product intermediate between albumin and 
peptone — Hemialbumin or Prope/ptone — has 
been found in the urine in two cases of osteoma- 
lacia. It differs somewhat in its reactions from 
both albumin and peptone, but is thrown down 
by the ordinary precipitants for these bodies. 

Peptone may be the only proteid found in a 
specimen of urine, or it may accompany albumin- 
uria. It often precedes albuminuria. I have 
found but few urines giving the peptone reac- 

3 



34 ABNORMAL CONSTITUENTS. 

tion. Just what pathological changes or condi- 
tion give rise to peptonuria have not been deter- 
mined. It has been noted in : — 

(1) General diseases, as — 
Diphtheria : 
Small-pox ; 

Typhus, typhoid and malarial fevers ; 
Cerebro-spinal meningitis ; 
Puerperal fever ; 
Septicaemia ; 

Acute phosphorus poisoning. 
In these diseases it is sometimes indicative of 
profound tissue changes. 

(2) Local inflammations — 
Croupous pneumonia (frequently) ; 
Pleurisy ; 

Acute nephritis ; 

Acute rheumatism ; 

Abscess ; 

During absorption of purulent exudates. 
It is especially liable to accompany inflamma- 
tions tending to the formation of pus, and in ob- 
scure cases of suspected suppuration it may be a 
valuable diagnostic sign. 

(3) Hepatic disorders. 

Dr. Oliver considers peptonuria to be caused 
by some defect in the constructive assimilation 
of the products of tryptic digestion. A portion 
of the peptone, absorbed from the intestine, 
passes through the liver into the general circula- 
tion, and is excreted by the kidneys. It is well 
known that proteids are converted into peptone 
by prolonged contact with animal tissues, and by 
the fermentative action of bacteria. Urine pep- 
tones may occasionally have such a source. 



ABNORMAL CONSTITUENTS. 35 

Detection. Of the reagents used for the detec- 
tion of albumin, peptone is precipitated by — 

Potassio-mercuric iodide ; 

Sodium tungstate ; 

Picric acid ; 

Acidulated brine. 
The precipitates by these reagents are soluble 
by heat. 

It is not precipitated by — 

Potassium ferrocyanide, nitric acid or heat. 
The precipitates by potassium iodide and picric 
acid are not distinguishable from those of alka- 
loids. Sodium tungstate gives a precipitate sol- 
uble upon heating, but it does not precipitate 
alkaloids. This reagent, then, forms a presump- 
tive test for peptones. Ralfe's modification of 
the biuret test is a ready clinical method ; the 
reaction, however, is not very apparent with small 
amounts of peptone. The phosphor-tungstate and 
biuret tests are the most accurate. 

Fibrin is met with in chylous urine, from 
which it is separated in a light gelatinous clot. 
It is recognized by its power of decomposing 
hydrogen peroxide with effervescence. 

Mucin. This proteid is a more or less con- 
stant constituent of normal urine. The hazy 
cloud which collects in the middle of a vessel of 
urine is mucus, made visible by the entangled 
epithelium, crystals and debris. It is particu- 
larly abundant in catarrhal inflammations of the 
genito-urinary tract. It is precipitated by alco- 
hol, dilute mineral acids and organic acids. 
Acetic or citric acid used by the contact method 
forms a convenient test for this proteid. Pus 
decomposed by alkalies forms a thick, glairy de- 



30 ABNORMAL CONSTITUENTS. 

posit in urine, which is not infrequently mistaken 
for mucus. 

The chief point of interest that attends the 
presence of mucin in the urine is its reaction to 
albumin precipitants. With some of these rea- 
gents it reacts similarly to albumin, and the ob- 
server should become familiar with these sources 
of fallacy in albumin testing. 

Dr. Oliver gives the following method of studying the 
mucin reaction : The clear saliva and a solution of salt (say 
20 grains to the ounce) should be mixed together in equal 
parts, and 1 drop of acetic acid or a citric paper should be 
added to a 4-inch column, which should then be thoroughly 
boiled, when the milkiness produced by a trace of albumin 
will appear. This highly muciferous solution is now added 
to albumin free urine — in such proportion as the observer 
may wish to charge it with mucin, e. g., 1 to 1 or 1 to 2, In 
any case the urine will then become more highly muciferous 
than is likely to be met with in the course of practice. Fil- 
tration may be dispensed with — being slow— if observation 
be checked by some of the untreated fluid, held by the side 
of that experimented on. A citric and a mercuric test paper 
added to 90 minims produces an opacity exactly like that 
induced by a small quantity of albumin ; but it differs from 
it in completely vanishing when heated. The opacity re- 
turns as the temperature of the solution falls, and in the 
cold it greatly exceeds the original amount. Heat will 
again disperse it as before. The characteristic feature of 
the reaction is the great increase of the opacity which fol- 
lows the clearing up by heat ; just in fact what occurs with 
normal urine, and also with urine which contains an excess 
of mucin. No doubt the observer, taking into account the 
highly muciferous character of the urine, will be surprised 
by the slightness of the reaction, after dropping in the test 
papers ; and he will moreover find that 10 minims of it, 
when added to the 60 minim solution prepared from the test 
papers (see page 121), gives the faintest tinge of milkiness, 
which heat, far short of boiling, completely removes. If 
now a trace of albumin be communicated to the mucin- 
charged urine — as by adding a little albuminous urine — the 
test papers will produce an opacity which heat will clear up 
only to a certain degree, that which remains over being due 
to the albumin. 



ABNORMAL CONSTITUENTS. 37 

GLUCOSE AND ALLIED BODIES. 

Glucose. C 6 H 12 6 . Glucose exists in the 

blood in from .81 to 1.231 parts per thousand. 
In diabetes it may rise to 5.0 parts per thousand. 
In health, with a diet not too rich in starchy and 
saccharine food, it does not appear in the urine. 
The quantity excreted in the urine varies from 3 
grains per ounce (8 grams per 1000 cc.) in phys- 
iological glycosuria, to 40 or 50 grains per ounce 
(80 to 100 grams per 1000 cc.) in diabetes. The 
average quantity excreted in diabetes is 20 grains 
per ounce (41 grams per 1000 cc.) The elimina- 
tion of 6 ounces (192 grams) in 24 hours is com- 
mon. One case is recorded in which 45 ounces 
(1350 grams) were discharged in one day. 

The reducing action of normal urine. With 
the indigo-carmine, copper, picric acid and other 
sugar tests, normal urine has a reducing action 
equivalent to from .5 to .7 grains per ounce (1.1 
grams per 1000 cc.) of glucose. The nature of 
the reducing agent has been a matter of much 
controversy. Many hold the opinion that a trace 
of glucose is a normal constituent of urine, and 
to it is due this reducing action ; while others 
believe inosite or some other member of the glu- 
cose group to be the reducing agent. Uric acid 
reduces the salts of copper, and to it many attrib- 
ute this action of normal urine. Very recent 
experiments by Dr. Geo. Johnson seem to prove 
that kreatinin is the body sought. He also finds 
that the urine during the ingestion of salicylic 
acid has a reducing action equal to one or two 
grains of glucose per ounce. It is well known 
that the administration of chloral has the same 



38 ABNORMAL CONSTITUENTS. 

effect. Sugar, in quantity detectable by the or- 
dinary tests, is found in the urine — 

Physiologically— 

During pregnancy and lactation ; 
Of infants under 2 months old ; 
Of old persons 70 to 80 years of age ; 
Of persons living largely upon starchy and 
saccharine food. 

Pathologically- 
Iii diabetes mellitus : 

In impeded respiration from pulmonary dis- 
eases ; 
In impeded hepatic circulation (functional 

and organic diseases of the liver) ; 
In diseases of the central nervous system 
(general paresis, epilepsy, dementia, 
puncture of fourth ventricle) ; 
In intermittent and typhus fevers ; 
By the action of certain poisons, as carbon 
monoxide, arsenic, chloroform and cur- 
rare ; 
In abnormally stout persons. 
The persistent excretion of easily recognizable 
quantities of sugar constitutes true diabetes. The 
quantity of urine in diabetes in 24 hours is gen- 
erally increased, often enormously so. The spe- 
cific gravity is high, varying from 1025 to 1050. 
It may, however, not be above normal ; excep- 
tionally it is below. The elimination during 24 
hours is increased. 

Tests for Glucose. The particular prop- 
erty of glucose which is utilized for its detection 
is its action as a reducing agent — its disposition 



ABNORMAL CONSTITUENTS. 39 

to absorb oxygen. In this property it differs 
strikingly from sucrose or common sugar. 

The Copper test. If a little copper sul- 
phate and an excess of liquor potassa be added to 
a solution of glucose, a clear blue solution results. 
Without the glucose the alkali would precipitate 
the pale blue cupric hydrate, CuH 2 2 ; and if 
the mixture were boiled this blue precipitate 
would be reduced to a black precipitate of cupric 
oxide, Cu0 2 . The clear blue solution containing 
glucose, however, when boiled, changes from 
transparent blue to opaque yellow, and speedily 
deposits a yellow, ultimately red precipitate of 
cuprous oxide CuO. When the quantity of sugar 
is large the change is immediate. When small 
the reaction takes two or three minutes for its 
completion. 

This is Trommer' s test : It is convenient, but 
open to the objection that, with small quantities 
of sugar, the reaction is liable to be obscured by 
a precipitate of cupric oxide. To avoid this diffi- 
culty, Rochelle salt is added to the copper solu- 
tion, the tartaric acid of which prevents the pre- 
cipitation of the cupric hydrate upon the addition 
of an alkali. 

Fehling's solution is thus prepared, and is the 
most convenient modification of the copper test. 
It is of definite composition, and is intended for 
a quantitative as well as a qualitative test. This 
solution readily decomposes. This may be obvi- 
ated to a considerable extent by having two solu- 
tions, one containing the cupric sulphate, and the 
other Kochelle salt and soda. The formula of 
Dr. A. B. Lyons of Detroit is an excellent one. 
Prof. W. S. Wayne proposed the substitution of 



40 ABNORMAL CONSTITUENTS. 

glycerine for the Rochelle salt. It produces a 
solution similar to Fehling's, but quite perma- 
nent. It is an excellent modification. Care 
must be used to select glycerin free from glu- 
cose. 

Precautions. A number of constant and occa- 
sional constituents of the urine interfere with the 
copper test. Albumin must be removed. Uric 
acid and inosite reduce the copper solution, but 
without the precipitation of the oxide ; the 
blue color is merely changed to green. Krea- 
tinine and ammonia tend to prevent the precipi- 
tation of cuprous oxide in urine containing sugar. 

Remarks. With careful regard for possible 
fallacies the copper test forms a sufficiently deli- 
cate and reliable test for glucose. It is not prac- 
ticable, however, for a bedside test. 

The Bismuth test. The principle of 
the test is the same as the copper test. The glu- 
cose reduces the salt of bismuth in the presence 
of an alkali. 

Precautions. The same as for the copper test. 

Remarks. The sources of fallacy are not so 
marked as in the copper test. It is a convenient 
bedside reagent. Sodium carbonate may be sub- 
stituted for the potassium hydrate. 

$Ioore's test. In this test the urine is 
boiled with potassium hydrate. If sugar be 
present the color changes to yellow or brown ; 
the intensity of the color being proportionate to 
the amount of sugar. 

Precaution. Albumin must be removed. 

Remarks. It detects, with certainty, large 
quantities of sugar in the urine, and may be used 
as a rough quantitative test. 



ABNORMAL CONSTITUENTS. 41 

The Picric Acid test. Advocated by 
Dr. Geo. Johnson. A little picric acid and an 
alkali are added to the urine and boiled one min- 
ute. If sugar be present, the solution becomes 
garnet red or deep brown, due to the formation 
of picramic acid, HC 6 H 2 NH 2 (1N T 2 ) 2 0. 

Precautions. The kreatinine in normal urine 
gives a color change equal to .5 to .7 grains of 
sugar per ounce. (.15 to .20 grams per 1000 cc.) 
With this exception, there are no fallacies. The 
presence of albumin is of no consequence. 

Remarks. This is an exceedingly valuable 
test. On account of the kreatinine reaction it 
cannot be used to detect minute quantities of 
sugar, but for all quantities above 1 grain per 
ounce (2.07 grams per 1000 cc), it is characteristic 
and accurate. It is a convenient bedside test, and 
Dr. Johnson has elaborated a fairly accurate and 
easily applied method of quantitative testing. 

The Fermentation test. Yeast added 
to a saccharine urine decomposes the glucose 
with the formation of carbon dioxide. The gen 
eration of gas under these circumstances proves 
the presence of sugar. 

Precaittions. The yeast must be fresh, and 
the temperature at which the experiment is per- 
formed must be high enough to favor the growth 
of the fungus (Tornla cerevisise). The proper 
temperature is from 68°to 75° F. (20° to 24° C.) 

Remarks. This is the most conclusive of the 
sugar tests. Its great disadvantage lies in the fact 
that it requires several hours to complete the 
experiment. It forms one of the most conven- 
ient quantitative methods. 



42 ABNORMAL CONSTITUENTS. 

Indigo-carmine {Mulder's test). Be- 

vived and strongly advocated by Dr. Oliver. If 
a solution of indigo-carmine of a distinctly blue 
tint, with a little sodium carbonate, be boiled 
with a trace of glucose, the blue color will change 
to purple, amethyst, red, and finally fade to pale 
yellow. With very minute quantities of sugar 
the color change is not complete ; it stops at the 
purple or red. As the oxygen of the air reaches 
the cooling solution the blue color is restored ; 
passing in reverse order through the same shades 
as in fading. The blue color may be restored by 
agitation, and bleached by rest if the fluid be 
kept hot. 

Precautions. Only one or, at most, two min- 
ims of the urine should be employed — at least in 
the first test. Normal urine will discharge the 
color of indigo if added in sufficiently large 
quantity — generally 5 minims of nominal urine 
are necessary to produce any change in 30 min- 
ims of a pale blue solution. 

Remarks. This test leaves but little to be de- 
sired. It is as delicate as Fehling's solution. 
When properly used, it is not affected by the 
presence of albumin, uric acid, or kreatinin. Of 
the many substances found in the urine of pa- 
tients undergoing medication, only tannic acid 
and the salts of iron reduce indigo. It is a con- 
venient pocket reagent, and keeps indefinitely. 
In the form of tablet, it has great advantages 
over every other glucose test. For nearly two 
years I have used it almost exclusively, reverting 
to the other tests only to confirm the indications 
of this. The test must be used in tablet form 
or test paper, as the proportion of pigment to 
soda must be always the same. 



ABNORMAL CONSTITUENTS. 43 

Iliosite, or muscle sugar, is occasionally 
found in the urine. Unlike glucose, it does not 
undergo vinous fermentation. It readily takes 
on lactic fermentation. The olive-green color 
which is sometimes produced with the copper 
test for glucose is thought to be due to the pres- 
ence of inosite. 

This body has been detected in the urine in — 
Diabetes mellitus (sometimes, especially dur- 
ing convalescence, replacing glucose.) 
Typhus fever ; 
Syphilis ; 
Phthisis. 

Lactose. Sugar of milk has been found in 
the urine of young infants and nursing women. 
Lsevulose, or fruit sugar, occasionally attends glu- 
cose in diabetes mellitus. 

Acetone. CO(CH 3 ) 2 . Normal urine does 
not contain this body. 

Pathologically it has been observed in — 
Diabetes ; 

Infectious diseases ; 
Febrile conditions in general ; 
Various cachexias ; 
Some functional brain diseases. 
It is particularly in diabetes that acetonuria 
occurs. The relation of the overloading of the 
blood with acetone, acetonemia, to diabetic coma, 
has been a matter of much discussion. It was 
formerly thought to be the cause of the coma. 
Human beings, however, tolerate larger doses of 
acetone, and the view is gaining ground that dia- 
betic coma is the result of various conditions. 



44 ABNORMAL CONSTITUENTS. 

Diacetic Acid. Diaceturia, a pathological 
occurrence, sometimes is seen in — 
Diabetes ; 

Mental disease with excitement ; 
Carcinoma ; 

Certain convulsive attacks in children (V. 
Jaksch). 
To this body also diabetic coma has been at- 
tributed. Both diacetic acid and acetone are 
probably decomposition products of glucose, and 
from the evidence we have up to this time it 
would appear that diabetic coma is sometimes the 
direct result of the formation and retention of 
large quantities of these compounds in the blood. 

BLOOD 

Is often a constituent of the urine of disease. 
Haemoglobin and the corpuscles may be present 
— hematuria; or haemoglobin without the cor- 
puscles — hemoglobinuria. 

Hematuria. Urine containing blood is red, 
brown or smoky, and deposits a red or brown 
sediment on standing. The color depends upon 
the alterations which the corpuscles and haemo- 
globin have undergone during their stay in the 
urine. Prolonged contact with the urine changes 
the bright red haemoglobin to methcemoglobin. 
This body imparts to the urine a brown, black- 
ish-brown or blackish -green color. 

Blood from the urethra, bladder or ureters, or 
if exuded from large vessels in the pelvis of the 
kidney or the kidney itself, is often but little 
changed, and is sometimes passed in clots. In 
capillary haemorrhage from the kidneys, the color 
is dark, and the blood thoroughly diffused in the 
urine. Small clots may be present. 



ABNORMAL CONSTITUENTS. 45 

Hematuria may have its source in — 

(1) The kidneys due to — 
Injuries ; 

Acute nephritis ; 

Acute exacerbation of chronic nephritis ; 

Diseases of renal vessel (embolism, throm- 
bosis, aneurism, stasis) ; 

Amyloid kidney (very rarely) ; 

Infective fevers (small-pox, scarlatina, ty- 
phoid fever, etc.) ; 

Certain blood diseases (scurvy, purpura, 
haemophilia) ; 

Parasitic diseases (echinococcus). 

(2) The pelvis and ureters, due to — 
Renal calculi ; 

Tuberculosis ; 

Rupture of neighboring abscesses ; 

Parasites. 

(3) The Madder, due to — 
Calculi ; 

Cancer and other tumors ; 
Diphtheritic cystitis ; 
Yaricose veins ; 
Injuries. 

(4) The urethra, due to — 

Injury (catheterization, impaction of cal- 
culi, etc.). 

(5) Extraiieous discharges, as — 
The menstrual flow, etc. 

Hmmoglobinuria. In this condition the bloody 
color is owing to the presence of dissolved blood 
pigment. The condition is produced when large 
numbers of blood corpuscles undergo dissolution 
within the vessels, since the kidne}'s very soon 
excrete the haemoglobin. For the relation of 



46 ABNORMAL CONSTITUENTS. 

haemoglobin .to certain forms of albuminuria, see 
page 24. 

Hsemoglobinuria has been observed — 

In severe infectious diseases (typhoid fever, 

scarlatina, etc.) ; 
In conditions of blood dissolution (scurvy, 

purpura, etc.) ; 
In skin burns, sunstroke ; 
As an independent disease (paroxysmal 

haemoglobin uri a — page 24) ; 
After transfusion of lamb's blood. 

BILE. 

In a number of pathological conditions the 
elements of the bile are excreted in the urine. 
The bile pigments, bilirubin and biliverdin, may 
occur along with the bile salts, sodium glycocho- 
late and taurocholate, or the bile salts alone may 
be present. 

Urine containing the bile pigments is colored 
yellow, brown or brownish-green. It forms an 
intense yellow froth on agitation. It stains paper 
or linen a permanent yellow. 

The bile pigments are found in jaundice from 
whatever cause. 

The significance and modes of detection of the 
bile salts in the urine have been the subjects of 
much speculation and controversy. Most authori- 
ties had come to look upon the methods of detec- 
tion of these salts as too complicated and unsat- 
isfactory to be of any clinical value. 

Dr. Oliver, in a recent original study of the 
subject, has brought out a ready test for these 
bodies, and has greatly enlarged our knowledge 
of the conditions which give rise to their secre- 
tion. 



ABNORMAL CONSTITUENTS. 47 

According to Dr. Oliver, the bile salts, in small 
quantities, are constantly excreted in the urine in 
health. Hygienic changes, as meteorological 
variations, changes in diet, etc., cause variations 
in their quantity. 

He has observed the quantity to be increased — 
During the daily periods of fasting ; 
After exercise. 
Pathologically he found the bile salts in- 
creased in — 
Jaundice ; 
Functional disorders of the liver (acute and 

chronic biliousness) ; 
Organic diseases of the liver apart from 
jaundice (carcinoma, amyloid disease, 
cirrhosis) ; 
Diseases of the spleen ; 
Fever ; 

Hemolytic diseases (anaemia, leucocytnaemia 
and scurvy). 
Tests for bile salts. Pettenkofer's test for bile 
salts has proven useless for clinical purposes. 
With rare exceptions the bile salts, if present in 
urine, must be isolated before the reaction will 
take place. This difficulty has led to the aban- 
donment of search for them. Dr. Oliver has 
recently brought forward a test, which can be 
readily applied, and which opens up a new field 
of clinical observation. 

In health the products of gastric digestion, 
peptone and parapeptone, leave the stomach in 
acid solution, meet the bile in the duodenum, 
and are precipitated in a tenacious layer over the 
whole mucous membrane. Upon this physio- 
logical fact is founded Dr. Oliver's test.. He 
uses an antiseptic, acidified solution of peptone. 



48 ABNORMAL CONSTITUENTS. 

With this reagent the bile salts in the urine are 
precipitated in the form of a milky opacity, the 
intensity of which depends upon the amount of 
bile salts present. The test is very delicate, de- 
tecting 1 part of the bile salts in 18.000 to 20.000 
parts of a solution of sodium chloride. Dr. Oli- 
ver's observations show that the bile salts are con- 
stituents of normal urine, and that variations in 
the amount present take place under a variety of 
physiological and pathological conditions. 

LEUCIN AND TYKOSIBT. 

These bodies, products of tryptic digestion and 
the decomposition of proteids, occur associated 
together in the urine in certain pathological con- 
ditions. They are symptomatic chiefly of grave 
destructive diseases of the liver, as — 
Acute yellow atrophy ; 
Acute phosphorus poisoning. 
They may present themselves in — 
Severe typhus ; 
Severe variola ; 
Leucocythemia ; 

After epileptic fits and brain injuries. 
When present they form a deposit, and may 
be detected by the microscope. 

FAT. 

Fat in a state of microscopic subdivision oc- 
curs in the urine in a variety of conditions. Two 
forms of fatty urine are recognized, chyluria and 
adiposuria. 

Chyluria. In this form of fatty urine the fat 
is in a chylous state. It occurs chiefly as a symp- 
tom of the presence of the embryos of the nema- 
toid worm jiliaria sanguinis hominis in the 






ABNORMAL CONSTITUENTS. 49 

blood. The chyluria in these cases is supposed 
to be due to the blocking up of the lymph ves- 
sels above the kidneys by masses of the embry- 
onic worms, and the consequent escape of the 
chyle into the urine. The same condition occurs 
also in other diseases, in which it is probable that 
some communication is opened up between the 
lymph vessels and the urinary tract. 

Adijoosuria may be present with or without 
renal disease. Fat may escape into the urine 
through a perfectly healthy kidney. It has been 
observed — 

. After the ingestion of fats and oils ; 
During the union of fractures ; 
In diseases of the pancreas ; 
In a case of acute diabetic coma (Ralfe). 
In cases of poisoning by phosphorus and car- 
bon dioxide ; 
In acute yellow atrophy of the liver; 
In yellow fever ; 
During pregnancy ; 

During chronic parenchymatous nephritis 
(from fatty degeneration of the renal 
epithelium). 



PART II. 



Practical Urine Analysis. 



CHAPTER L 



SYSTEMATIC SCHEME FOR QUALITATIVE 

ANALYSIS. 

Selection of a Specimen of Urine. 

Whenever possible a sample of the whole urine 
passed in 24 hours should be examined, as the 
composition varies to quite a degree at different 
periods of the da} 7 . Erroneous conclusions may 
be drawn from the analysis of an isolated speci- 
men. When a sample of the whole day's urine 
cannot conveniently be obtained, the first and 
second morning evacuations mixed together form 
an approximately average specimen. 

i. Hake a note of the quantity passed 
in 24 hours, the color, the odor, the trans- 
parency, and the consistence. 

2. Determine tiie specific gravity. 

(a). With the urinometer. Fill the cylinder to 
within an inch of the top with the urine. Bring 
the urine to the temperature for which the uri- 
nometer is graduated, by immersing the cylinder 
in hot or cold water, as may be necessary. Float 
the urinometer in the fluid, and then completely 
fill the cylinder. Take the reading at the highest 
point, where the surface of the liquid comes in 
contact with the stem. 

Urinometers are usually graduated for a tem- 
perature of 60° F. When the temperature at 
which the observation is taken is above this point, 



54 



QUALITATIVE ANALYSIS. 



add, and when below, subtract, 1 degree of spe- 
cific gravity for every 6 degrees F. of tempera- 
ture for approximate correction. Correct accu- 
rately by Dr. A. B. Lyons' table, as follows : 



Tem- 


Correction. 

Subtract 

from reading 

of Urino- 

meter. 


Tem- 


Correction. 


Tem- 


Correction. 


pera- 
ture. 


pera- 
ture. 


Add to 
reading of 


pera- 
ture. 


Add to 
reading of 


Fahr. 


Fahr. 


Urinometer. 


Fahr. 


Urinometer. 


50° 


1.05 


61°.... 


0.11 


79°.... 


2.49 


51 


95 


62 .... 


0.22 


80 .... 


2.63 


52 


0.84 


63 .... 


0.34 


81 .... 


2.78 


53 


0.74 


64 .... 


0.45 


82 .... 


2.94 


54 


0.64 


65 .... 


0.57 


83 ... 


3.10 


55 ... . 


0.53 


66 .... 


0.69 


84 .... 


3.26 


56 


0.43 


67 .... 


0.82 


85 ... 


3.42 


57 


0.32 


68 .... 


0.95 


86 .... 


3.58 


58 


0.22 


69 .... 


1.08 


87 .... 


3.75 


59 


0.11 


70 .... 


1.22 


88 .... 


3.91 


60 


0.00 


71 .... 


1.35 


89 .... 


4.08 






72 .... 


1.49 


90 .... 


4.24 






73 .... 


1.62 


91 .... 


4.40 






74 .... 


1.76 


92 .... 


4.57 






75 .... 


1.90 


93 .... 


4.74 






76 .... 


2.04 


94 .... 


4.91 






77 .... 


2.19 


95 .... 


5.09 






78 .... 


2.34 







If the quantity of urine be too small to fill the 
cylinder use the specific gravity bead ; or, dilute 
with one, two or more volumes of pure water. 
From the specific gravity of this mixture, taken 
with the urinometer, calculate that of the urine. 

EXAMPLE. 

Urine, 1 volume. 

Water, 3 volumes. 

Specific gravity of mixture 1.004. 

1.000+(4X4)=1.016 

(b) With the specific gravity bead — 
The bead just floats in fluid of a specific grav- 
ity of 1.005. 

Drop the bead into a small test tube and 
add 25 minims of urine. If the bead float, 
the specific gravity is below 1.005. If the 
bead sink, cautiously add water, 25 minims at a 



QUALITATIVE ANALYSIS. 55 

time, and mix it thoroughly with the urine. 
Watch for a tendency of the bead to rise. When 
this time approaches add the water, 5 minims at 
a time, until the bead is just suspended in the 
fluid, neither rising nor falling. Calculate the 
result. Each five minims of water added equals 
one " degree " (.001) of specific gravity. 

EXAMPLE. 

Urine, 25 minims. 
Water adde d, 85 minims. 
5)110 
22 
Specific gravity=1.022. . 

Urine of very high specific gravity, 1.030 or 
above, may be diluted one-half, and the result 
multiplied by two. 

3. Determine the Reaction. Dip a 

red and a blue litmus paper in the urine. If the 
blue turns red the reaction is acid; if the red 
turns blue the reaction is alkaline; if no change 
take place in either the reaction is neutral. 

If the reaction be alkaline dry the test paper. 
If the blue color be permanent the alkalinity is 
due to fixed alkali, soda or potassa ; if the blue 
color disappear the alkalinity is due to volatile 
alkali, ammonia. 

4. Test the Specimen for Proteids. 

If the urine be not perfectly clear, filter. Tur- 
bidity from urates may be dissipated by heat ; 
from phosphates, by a few drops of acetic acid. 

If the turbidity be due to amorphous phos- 
phate and microbes, as in old alkaline urines, and 
the urine be not rendered perfectly clear by or- 
dinary filtration, add about one-fourth its volume 
of solution of potassa, warm and filter. If the 
filtrate still be turbid add a few drops of the 



56 QUALITATIVE ANALYSIS. 

magnesian fluid, warm again and filter. The 
urine will then be clear. When this process is 
necessary heat cannot be used as a test. 

(a) General Test for Proteids. To 

about 60 minims (4 cc.) of urine in a small test 
tube add a few drops of potassio-mercuric iodide. 
Or, dissolve a mercuric and a citric acid tablet in 
60 minims (4 cc.) of water, and add 15 minims (1 
cc.) of the urine. 

No precipitate. Proteids are absent. Pass 
to (5). 

A precipitate. Albumin, globulin peptones, 
alkaloids {urates, mucin). 

Boil. The precipitate remains. Albumin. 
Confirm by heat, or one or more of the other spe- 
cial albumin tests. Search for serum globulin, 
which behaves like albumin, by special tests, if 
the presence of this body be suspected or its 
recognition desired. 

The precipitate dissolves. Peptones, alka- 
loids iterates, mucin). 

To distinguish between these bodies add a few 
drops of the sodium tungstate solution to 60 
minims (4 cc.) of the urine. Or, dissolve a tung- 
state and a citric acid tablet in 60 minims (4 cc.) 
of water, and add 15 minims (1 cc.) of the urine. 

A precipitate. Peptones {urates, mucin). Con- 
firm the presence of peptones by special tests. 

No precipitate. Alkaloids. 

(b) Special tests for Serum Alfon- 
infn. 

Heat. If not already markedly acid add a 
drop of acetic acid or a citric acid tablet to 3 or 
4 drachms of the urine in a test tube. Hold the 
bottom of the tube between the thumb and finger, 



QUALITATIVE ANALYSIS. 57 

and heat the upper half to the boiling point. 
Any precipitate or cloudiness is albumin. 

Potassium Ferrocyanide. Strongly acidify a 
dram of the urine with acetic acid and add a few 
drops of the ferrocyanide solution. Or, dissolve 
a ferrocyanide and a citric acid tablet in 60 
minims (4cc.) of water and add 15 minims (1 cc.) 
of the urine. 

Any precipitate is albumin. 

Picric Acid. Add to 60 minims (4 cc.) of 
urine an equal volume of the picric acid solution, 
and heat to near the boiling point. Or, dissolve 
a picric acid tablet in 60 minims (4 cc.) of 
water and add 15 minims (1 cc.) of urine and 
heat to boiling. 

Any remaining precipitate is albumin. 

Sodium Tungstate. Add a few drops of the 
acidified sodium tungstate solution to 60 minims 
(4 cc.) of the urine and heat to near the boiling 
point. Or, dissolve a sodium tungstate and a 
citric acid tablet in 60 minims (4 cc.) of water 
and add 15 minims (1 cc.) of the urine and heat 
to boiling. 

Any remaining precipitate is albumin. 

Nitric Acid. Pour about 30 minims (2 cc.) 
of pure, colorless nitric acid into a test tube. 
Incline the tube at an angle of about 45°, and 
allow about 60 minims (4 cc.) of the urine to 
slowly trickle down the side of the tube from a 
small pointed pipette and overlie the acid. (See 
page 122.) 

A white ring at the 'point of contact is albumin. 

Caution. (1) Urates sometimes form a haz}' 
ring, but above the point of contact. (2) Urines 
highly charged with urea may give a crystalline 
ring of nitrate of urea. Both these rings are dis- 
pelled by the application of a gentle heat. To 



58 QUALITATIVE ANALYSIS. 

apply heat without disturbing the ring, immerse 
the tube in hot water. (3) The urines of per- 
sons taking the oleo-resins may precipitate with 
nitric acid. This ring is dissolved by alcohol. 
(4) Urines highly charged with normal pig- 
ments, or those containing bile pigment, give a 
colored ring which may obscure a delicate ring 
of albumin. 

This mode of applying the nitric acid test is 
termed the contact or Heller's method. It is 
an excellent method of using a number of rea- 
gents, and is frequently spoken of in the text. 

(c) Special Tests for Peptone. 

Balfe's Test. Place 30 or 40 minims (2 or 3 cc.) of 
Fehling's solution in a test tube and gently over- 
lay it with the urine. At the point of contact a 
zone of phosphates appears. Above this, if pep- 
tones be present, a rose-colored halo will develop. 
If albumin be present with peptones the color 
will be mauve ; if albumin alone, purple. 

Phosphor- Tung state Test. Free from mucin 
and decolorize an ounce or two of the urine by add- 
ing to it solution of neutral lead acetate until the 
precipitate no longer increases ; filter. Acidify 
the filtrate with acetic acid and add a few drops 
of solution of potassium ferrocyanide. Any 
precipitate is due to albumin. To remove the 
albumin continue the addition of the ferrocyanide 
so long as a precipitate occurs, and filter. 

To this albumin-free filtrate add one-fifth its 
bulk of acetic acid and then an acid solution of 
sodium phosphor-tungstate. Any cloudiness is 
peptone. (The formation of the precipitate may 
be delayed ten minutes or more.) 

(d) Special Test for Serum Glob- 
ulin. If necessary, slightly acidify the urine 



QUALITATIVE ANALYSIS. 59 

with acetic acid, filter, and dilute with clear 
water to a specific gravity of 1.002. A cloudi- 
ness indicates serum globulin. 

For a more delicate test pass carbon dioxide 
through this diluted urine. Serum globulin 
gives a cloudiness. 

(e) Special Test for Mucin. Place 30 

minims (2 cc.) of acetic acid in a test tube and over- 
lay it with the urine. A cloud appearing, usually 
after some minutes, above the point of contact of 
the two fluids, insoluble by heat, indicates mucin. 

(5) Test the Specimen for Glucose. 

The urine should be fresh. JSTo test for glucose 
can be trusted with decomposing urines. Uric 
acid, kreatinine, albumin, pus, or other ordinary 
physiological or pathological constituents of urine 
do not interfere with the indigo-carmine, picric 
acid or fermentation tests. Before using any of 
the other tests, however, remove albumin, if it 
be present, by boiling and filtration. 

The Indigo-Carmine Test. Add 60 minims 
(4 cc.) of distilled or rain water to an indigo- 
carmine tablet or an indigo-carmine and half a 
sodium carbonate test paper and boil. 

Add one drop of the urine to the solution and 
keep it at the boiling point without agitation. 

If no color change take place by the end of 
two minutes glucose is absent. Pass to (6). 

If glucose be present, a beautiful violet tint sud- 
denly breaks out in the blue solution ; the color 
quickly changes to purple, red, orange, and finally 
becomes straw-colored. Now shake the tube and 
the colors return in the inverse order in which 
they appeared. The rapidity with which the 
color changes develop depends upon the amount 



60 QUALITATIVE ANALYSIS. 

of glucose present. If glucose be present in very 
minute quantity the color change may be arrested 
before the yellow is reached. 

Confirm the presence of sugar by one or more 
of the following tests : 

The Copper Test. Pour 60 minims (4 cc.) of 
Fehling's solution, or one of its modifications, 
into a test tube and heat to boiling. If any 
turbidity or change of color take place in the 
solution it is unfit for use and must be rejected. 
If it remain clear, add a drop of the urine (which 
must be freed from albumin, if present), and heat 
gently. If a large quantity of sugar be present 
a yellow precipitate, turning red, will be formed. 
If no precipitate appear add a drop or two more 
urine, and so on until a bulk equal to the amount 
of the Fehling's solution used has been added. 
If no precipitate then appear, sugar is abse?it. 

In typical glucosuria the precipitation of the 
cuprous oxide is too marked to be mistaken. 
With very minute quantities of glucose, however, 
the reaction may be so faint as to cause confusion. 
It is then greenish-yellow and indistinct. After 
standing a short time a few grains of cuprous 
oxide will deposit at the bottom and along the 
sides of the tube. 

Inosite gives a greenish coloration, but no pre- 
cipitate. 

Excess of uric acid, as we have seen, has a 
slight reducing action on the salts of copper, and 
a reaction by this compound may simulate that 
of glucose. To decide this question, add to the 
urine solution of neutral lead acetate, filter, and 
test the filtrate with the copper solution. If no 
reaction now result the former reaction was due 
to uric acid. 



QUALITATIVE ANALYSIS. 61 

The Fermentation Test. For the most con- 
venient apparatus for making the fermentation 
test see page 82. 

Moore's Test. To 60 minims (4 cc.) of the urine 
add 30 minims of solution of soda or potassa. A 
flaky precipitate of phosphates appears. Boil the 
solution. If glucose be present a yellow color 
quickly appears, darkening to brown as the boil- 
ing is continued. The intensity of the color 
varies with the amount of glucose. If the quan- 
tity be large the color becomes almost black. 
ISTow add a few drops of nitric acid ; the color 
disappears and the odor of burnt molasses is de- 
veloped. 

Picric Acid Test. To 60 minims (4 cc.) of the 
urine add an equal bulk of saturated solution of 
picric acid ; albumin, if present, will precipitate. 
Add about 20 minims (1.4 cc.) of solution of po- 
tassa and apply heat. A deep red-brown color, 
developing gradually, indicates glucose. The in- 
tensity of the color varies with the amount of 
glucose present. 

Caution. Nearly all urines treated in this way 
become darker in color, a color about the same as 
that produced by a solution of glucose of .4 to .7 
grains per ounce. The reaction of normal urine 
should be studied before this test is used. 

The Bismuth Test. To 30 minims (2 cc.) of 
the urine add an equal bulk of solution of potassa 
and a pinch of bismuth sub-nitrate, and boil for 
a minute or two. If sugar be present black metal- 
lic bismuth deposits. 

(6) Test the Specimen for I iidican. 

Into 60 minims (4 cc.) of hydrochloric acid con- 
tained in a small beaker, wine glass or large test 
tube, let fall about 20 drops (1.5 cc.) of the 
urine. Stir the fluid. 



62 QUALITATIVE ANALYSIS. 

A pale yellowish-red color develops. 

The indican is normal in amount. 
The fluid becomes violet or blue. 

The indican is in excess. 
The intensity of the color is directly propor- 
tionate to the amount of indican present. 

(7) Test the Specimen for Blood 

Pigment. . Heller's Test for Hcematin. Pre- 
cipitate the earthy phosphates from a drachm or 
two of urine by caustic potash and a gentle heat. 
If the phosphates appear blood-red or dichroic, 
blood pigment is present. 

If the urine is alkaline and a precipitate does 
not form upon the addition of the potash, add 
one or two drops of the magnesian fluid and heat 
gently. 

The preparation of crystals of Hcemin {hydro- 
chlorate of hcematin). Collect the blood-colored 
phosphates upon a filter, trans- 
fer the precipitate to a glass 
slide, and carefully warm until 
it is perfectly dry. Thor- 
oughly mix a small crystal of 
sodium chloride with the phos- 
phates, remove excess of salt, 
add a drop of glacial acetic 
* acid and cover with a thin 

Fig. l. Haemia Crystals, glass. Warm the slide care- 
fully till bubbles begin to form. Cool the slide 
and examine under the microscope with a Jori 
objective. Hsemin crystals appear. (Fig. 1.) 

Alemerts Test. Shake togetiier equal parts of 
oil of turpentine and tincture of guaiac, add drop 
by drop about the same quantity of urine. Allow 
the emulsion to separate. Blood gives a blue or 
greenish-blue color to the upper layer. 




QUALITATIVE ANALYSIS. 63 

(8) Test the Specimen for Bile. 

(a) Bile Pigments. Gmelin's Test. 

Dilute very dark urines with water. Underlay 60 
minims of urine with fuming nitric acid. At the 
point of contact of the fluids, if bile pigment be 
present, a set of colors will slowh 7 develop. 
Uppermost will be green, and following down- 
ward in order will be blue, violet, red and yellow. 
Often one or more colors are absent. The green 
is, however, necessary to prove the presence of 
bile. 

Or, place a few drops of urine and the fuming 
acid near each other on a white plate and allow 
them gradually to approach and commingle. 
The same play of colors appears. 

Or, drop a little of the urine and the fuming 
acid on a piece of white blotting paper and then 
allow them to come in contact. 

FleicMs method. This is more delicate than 
Gmelin's method. Mix thoroughly equal quan- 
tities of pure colorless nitric acid and the urine, 
and underlay this mixture with concentrated sul- 
phuric acid. The colors appear at the point of 
contact. 

Heller's method. Add to 60 minims (4 cc.) of 
hydrochloric acid, drop by drop, just enough 
urine to color it. Underlay the mixture with 
pure nitric acid. The colors appear at the point 
of contact. 

To detect a very small quantity of pigment, 
shake two ounces of urine with a drachm of chlor- 
oform and allow the chloroform to settle to the 
bottom. Withdraw the chloroform with a pi- 
pette, wash it in water, and pour it into a beaker 
containing a drachm or two of hydrochloric acid. 
Shake the beaker, and while shaking add nitric 



64 QUALITATIVE 'ANALYSIS. 

acid. The changes of color can be observed in 
the chloroform. 

(6) Bile Salts. Dr. Oliver's Peptone Test. 
If necessary make the urine clear by filtration, 
boil and filter if bloody, make normally acid if it 
be alkaline, and reduce it by dilution with pure 
water to a specific gravity of 1008. (The object 
of this dilution is to have such uniformity as to 
admit of quantitative comparison, and to reduce 
the possibility of errors which might occur with 
concentrated urines.) Add 20 minims (1.4 cc.) 
of the diluted urine to 60 minims (4 cc.) of the 
peptone solution. (See page 122.) 

~No immediate reaction is produced, but in a 
little while a slight milkiness appears. The bile 
salts are normal in amount. 

A distinct milkiness promptly appears, becom- 
ing more intense in a minute or two. The bile 
salts are in excess. 

The degree of opacity is directly proportionate 
to the amount of bile derivatives. 

Or, overlay 60 minims (4 cc.) of the diluted 
urine in a test tube with the peptone solution. 

There is no response, or a delicate threadlike 
line slowly appears. The bile salts are normal. 

An immediate and marked reaction takes 
place. The bile salts are in excess. 

This precipitate of the bile salts with peptone 
is diminished by boiling and dissolved by acetic 
acid. 

Pettenkofer's Test. As morphine, albumin and 
other occasional constituents of urine react to 
Pettenkofer's test in the same manner as the bile 
salts, it is necessary in testing for these bodies 
first to isolate them. 



QUALITATIVE ANALYSIS. 65 

To accomplish this, evaporate about 2 ounces 
(60 cc.) of the suspected urine to dryness over a 
water bath. Extract the residue with about 90 
minims (6 cc.) -of alcohol, filter and mix with 
about 2 ounces (60 cc.) of ether. Collect the 
precipitate which is formed on a small filter, wash 
it with ether, and dissolve in 15 to 30 minims 
(1 to 2 cc.) of distilled water. This fluid contains 
the bile salts in solution. 

Now apply Pettenkofer's test. To the solution 
obtained as above add 1 drop of a solution of 
cane sugar (1 to 3). Underlay" this mixture with 
a littlesulphuric acid. If bile be present a purple- 
red zone forms at the junction of the two fluids, 
which gradually diffuses throughout the mixture, 
forming after a few hours a homogeneous dark 
red liquid. 

(9) Test the Specimen for Chlor- 
ides. To 60 minims (4 cc.) of the urine add a 
few drops of pure nitric acid, to hold phosphates 
in solution, and a drop or two of solution of silver 
nitrate. The chlorides give a heavy white pre- 
cipitate, falling in cheesy lumps if the chlorides 
are normal in amount. If greatly decreased a 
cloudiness only is produced. 

(io) Test the Specimen tor Phos- 
phates. To 60 minims of the urine add a few 
drops of the magnesian fluid and heat gently. 
The phosphates separate in a cloudy precipitate. 

(li) Test the Specimen for Sul- 
phates. To 60 minims of the urine add a few 
drops of hydrochloric acid, to hold phosphates in 
solution, and then add a few drops of barium 
sulphate. The sulphates form an opaque milky 
cloudiness. 



66 QUALITATIVE ANALYSIS. 

(12) Test the Specimen for Acetone 

or the acetone producing body, when this sub- 
stance is suspected to be present. To 60 minims 
(4 cc.) of the urine in a test tube add a little solu- 
tion of ferricchloride. A deep red coloration is 
produced, which is destroyed by hydrochloric 
acid. 

Balfe's test. Boil together in a test tube 60 
minims of liquor potassse and 20 grains of potas- 
sium iodide. Carefully float upon the surface 60 
minims of the suspected urine. A ring of phos- 
phates forms, which after a few moments, if the 
acetone or its allies be present, becomes yellow, 
and studded with yellow points of iodoform. In 
time these will sink through the phosphates to 
the bottom of the tube. 



CHAPTER II. 



QUANTITATIVE ANALYSIS. 

(l) Estimation of the total Urin- 
ary Solids. Approximate method. The 
specific gravity of urine varies with the total dis- 
solved solids. The amount of solid urine may 
therefore be estimated from the specific gravity. 
Either of the two following methods, which give 
about the same results, may be used. The first 
is the more convenient : 

(a) Multiply the last two figures of the spe- 
cific gravity by the number of ounces of urine 
discharged in 24 hours. The product will be 
the number of grains of solid matter. 

EXAMPLE. 

Specific gravity of urine, 1.018. 

Number of ounces, 42. 
18X42=756 grains in 24 hours. 

(b) Multiply the last two figures of the specific 
gravity by 2.33, the coefficient of Hseser. The 
product will be the number of grams of solid 
matter in 1,000 cc. (33.8 oz.) of urine. 

EXAMPLE. 

Quantity in 24 hours, 1,200 cc. 
Specific gravity of urine, 1,024. 
24X2.33=55.92 grams in 1,000 cc. 

Calculate the amount in the 24 hours' urine as 
follows: 

55.92X1200 

1000 1 1200 : : 55.92: x x = =67.10 grams. 

1000 

These methods give results sufficiently accurate 
for all clinical purposes. 



68 



QUANTITATIVE ANALYSI8. 




QUANTITATIVE ANALYSIS. 69 

(2) Estimation of Urea. Variation in 
the amount of urea from the standard mean is so 
great that even rough approximate methods of 
estimation often serve well for clinical purposes. 
The approximate estimation from the specific 
gravity is a ready means of selecting, in the pre- 
liminary examination, particular urines for more 
accurate analysis. 

For accurate estimation some modification of 
the hypobromite process is the most convenient. 

The Hypobromite process. Principle. 
Urea is decomposed by a hypobromite (or a 
hypochlorite) into nitrogen, carbon dioxide and 
water. 
CON 2 H 4 +3NaBrO=:3NaBr+C0 2 +2H 2 0+N. 2 . 

The carbon dioxide is absorbed b}' the alkali 
and the volume of the disengaged nitrogen meas- 
ures the amount of urea. Several forms of 
apparatus have been devised to decompose the 
urea and measure the amount of gas. The 
ureometer designed by Dr. A. B. Lyons of 
Detroit, and manufactured by Parke, Davis & 
Co., is cheap, accurate and convenient. 

The apparatus (Fig. 2) consists of — 

1. A bottle, provided with perforated rubber 
cork and deliver}^ tube; in this the decomposition 
of the urea is effected. 

2. A small test tube to contain the urine, 
graduated to hold 4 cc, the quantity employed 
in each experiment. 

3. A graduated jar for measuring the gas 
evolved. This jar is provided at the bottom 
with an " overflow " tube, and at the top with a 
vent tube closed with a rubber cap, to secure 
accurate adjustment of the level of the fluid in 
the jar at the commencement of the experiment. 



.¥ 



70 QUANTITATIVE ANALYSIS. 

This receiver is graduated in such a way that the 
results are read off directly in percentages of 
urea. 

The solution of sodium hypobromite is difficult 
to prepare and does not keep. These facts make 
the method with this reagent an inconvenient 
one. In the place of the hypobromite, the 
IT. S. P. solution of chlorinated soda (Labarra- 
que's solution) may be used. Dr. Lyons has 
found, however, that the amount of gas generated 
when the chlorinated soda is used is considerably 
less than that evolved by hypobromite solution. 
Further, the gas is evolved much more slowly, 
and the reaction does not appear to be complete 
even when a large excess of the reagent is em- 
ployed. 

Dr. Lyons overcomes this difficulty by chang- 
ing the hypochlorite into hypobromite extem- 
poraneously. He simply adds to the solution of 
clorinated soda, of which 25 cc. should be suffi- 
cient to decompose the urea in 4 cc. of urine, 
5 cc. of a 20 per cent, solution of potassium bro- 
mide a few minutes before the urine is intro- 
duced. With this modification he obtains re- 
sults identical with those reached by the hypo- 
bromite process. 

Process. Put into the bottle 25 cc. (7 
fluidrachms) of solution of chlorinated soda and 
5 cc. (75 minims) of the 20 per cent, solution of 
potassium bromide. Fill the test tube exactly to 
the mark (4 cc.) with the urine to be examined, 
and lower it into the bottle by means of a thread, 
or by the aid of a pair of dressing forceps, taking 
care that none of its contents are spilled in the 
operation. Fill the graduated jar with water, 
which must be of the same temperature as the air 



QUANTITATIVE ANALYSIS. 71 

of the room, to a point a little above the zero mark 
of the scale, supporting the extremity of the over- 
flow tube so that no water can escape. Remove 
the rubber cap from the vent tube and connect 
the apparatus, pressing in the rubber corks firmly 
so as to make the joints air-tight. Finally put 
on the rubber cap, drawing it down so as to force 
a little water out of the overflow tube, and bring 
the level of the water remaining exactly to the 
zero mark, the orifice of the overflow tube being 
on the same level. A little practice will make 
this easy. 

To make sure that the connections are all per- 
fectly air-tight, lower the end of the overflow 
tube a few inches; a few drops of water will 
escape from diminished pressure, but if the 
joints are perfect there will be no further drop- 
ping. If there is any leakage, the defective 
joint must be found and the difficulty corrected 
before proceeding further with the experiment. 
Having made sure that the connections are per- 
fect, catch the curved end of the overflow tube 
over the edge of a measuring graduate, as shown 
in the illustration (an ordinary bottle or any 
other receiver may be used in place of the grad- 
uate). Now, by canting the bottle, cause the 
urine to flow out of the test tube and mix with 
the hypobromite solution. Effervescence is at 
once produced, and the gas evolved forces a 
corresponding volume of water out of the over- 
flow tube. Shake the bottle occasionally to pro- 
mote the escape of the gas. When the action 
appears to be at an end, pour into the measuring 
graduate water enough to reach above the open- 
ing of the overflow tube, in order that cooling of 
the gas evolved, which is at first quite warm, may 



n 



QUANTITATIVE ANALYSIS. 



not draw air into the apparatus. Let the appa- 
ratus stand 15 or 20 minutes to cool, then shake 
the bottle containing the urine once more and 
proceed to read off the result. To do this, it is 
necessary to bring the opening at the end of the 
overflow tube just to the same level as that of 
the fluid remaining in the graduated cylinder, 
since raising or lowering the tube slightly affects 
the volume of the gas to be measured. The per- 
centage of urea is read off without need of any 
calculation from the scale of the instrument. 

If desired, calculate from the percentage the 
quantity in grains in one fluid ounce by the fol- 
lowing table : 



Per cent, of 

urea by 
ureometer. 

0.1 

0.2 .. 


Quantity of urea 

in grains 

in i fluidounce. 

456 

911 


0.3 

0.4 


1.367 

1.823 


0.5 


2.279 


0.6 


2.734 


0.7 


3 . 190 


0.8 


3.646 


0.9 


4.101 


10 


4.557 


11... 


5.013 


1 2 


5.468 


1 3 


5.924 


1.4 

15 


6.380 

6.836 


1 6 


7.291 


1.7 


7.747 


1.8 


8.203 



Per cent, of Quantity of urea 

urea by in grains 

ureometer. in i fluidounce. 

1.9 8.658 

2.0 9.114 

2.1 9.570 

2.2 10.025 

2.3 10.481 

2.4 10.937 

2.5 11.393 

2.6 :..11.849 

2.7 12.394 

2.8 12.760 

2.9 13.215 

3.0 13.671 

3.1 14.126 

3.2 ...14.582 

3.3 15.038 

3.4 15.494 

3.5 15.950 



Fowlefs method. Principle. The dif- 
ference in the specific gravity of urine, before 
and after its decomposition by the hypochlorites, 
bears a definite relation to the quantity of urea 
present. Every degree of specific gravity lost 
corresponds to .77 of 1 per cent, of urea, or about 
3^ grains per ounce. Squibb' s solution of chlor- 
inated soda — Labarraque's solution — is employed ; 



QUANTITATIVE ANALYSIS. 73 

7 parts of the solution will decompose the urea in 
1 part of urine. 

Process. Take the specific gravity of the 
urine and of some chlorinated soda solution at 
the same temperature. Add 1 volume of the 
urine to 7 volumes of the hypochlorite solution. 
Effervescence due to the liberation of nitrogen 
takes place. Shake the mixture at intervals dur- 
ing an hour. Now take the specific gravity of 
the mixture at the same temperature at which 
the other observations were made. Add once 
the specific gravity of the urine to seven times 
the specific gravity of the soda solution, and 
divide the sum by eight. From the quotient 
subtract the specific gravity of the mixture after 
decomposition, and multiply the difference by 
.7791. The product is the amount of urea in 
grams in 100 cc. of urine. Determine amount 
in 24 hours by multiplying this result by ^ w of 
the quantity excreted in 24 hours. 

EXAMPLE. 

Quantity of urine in 24 hours, 1400 cc. 

Specific gravity of hypochlorite solution, 1048. 

Specific gravity of urine, 1018. 

Specific gravity of mixture j 1 048x7+1018 | =1044 ^ 
before decomposition, ~j g i ■ 

Specific gravity of mixture after decomposition, 1041.25. 

1044.25—1041.25=3. 

.7791X3X14.00=32.72 grams in 24 hours. 

(3) Estimation of Uric Acid. The 

amount of uric acid may be determined directly 
by . separating and weighing it. 

Process. To 200 cc. of urine add 20 cc. of 
hydrochloric acid and set aside in a cool place for 
24 hours. Uric acid crystals form and collect on 
the bottom and sides of the vessel. Collect the 
uric acid on a weighed filter and wash thoroughly 



74: QUANTITATIVE ANALYSIS. 

with water. Dry the filter and the uric acid at 
a temperature of 212 F. (100 C.) and weigh them. 
The weight of the two minus the weight of the 
filter will be the amount of uric acid in 200 cc. 
of urine. From this calculate the amount in 24 
hours. (See page 123.) 

(4) Estimation of Chlorides. Ap- 
proximate clinical method. Add to the urine 
a few drops of nitric acid and a single drop of 
silver nitrate solution. If the precipitate fall in 
firm cheesy lumps the chlorides are normal (i 
to 1 per cent.) If the silver produce but a milky 
cloudiness the chlorides are diminished, T V per 
cent, or less. 

Mohr' s method. Principle. If silver ni- 
trate be added to a solution containing sodium 
chloride, neutral potassium chromate, and an 
alkaline phosphate, the chloride is first precipi- 
tated, then the chromate, and lastly the phos- 
phate. The formation of the red silver chromate. 
indicates the complete precipitation of the 
chloride. 

Solutions required — 

1. Standard solution of silver nitrate. 

Fused silver nitrate 29.075 grams. 
Distilled water to make 1000 cc. 
1 cc.=0.01 NaCl. 

2. Saturated solution neutral potassium chro- 
mate. 

Neutral potassium chromate 10 grams. 

Distilled water 100 cc. 

Process, (a) The urine is not high colored, 

and is free from albumin or excess of uric acid 

or mucus. Dilute 10 cc. of the urine with 100 

cc. distilled water and add a few drops of the 



QUANTITATIVE ANALYSIS. 75 

ehromate solution. Fill a burette with the silver 
solution to the zero mark. Drop it slowly into 
the urine, stir it well and watch for the first 
trace of orange color. Make sure that the pre- 
cipitation of the chloride is complete by adding 
another drop. Read off the amount of silver 
solution used and calculate the result. 

EXAMPLE. 

Quantity of urine in 24 hours, 1250 cc. 
Silver solution used 7.5 cc. 
1 cc. silver solution=.01 sodium chloride. 
.01X7.5 

Xl,250=9.475 grams. 

10 

(b) The urine is high colored, and contains 
albumin, or excess of uric acid or mucus. These 
compounds must be removed. To do this meas- 
ure 10 cc. of the urine into a platinum capsule, 
add 2 grains of pure potassium nitrate, evaporate 
to dryness, and ignite at a dull red heat to de- 
stroy organic matter. When cool, treat the resi- 
due with hot water and filter; acidulate the 
filtrate with dilute nitric acid, neutralize with 
carbonate of lime and proceed as in (a). 

(5) Estimation of Phosphates. Teis- 
sier's approximate method. Pour 50 cc. of 
urine (made distinctly acid if necessary by a few 
drops of nitric acid) into a graduated cylinder, 
and saturate it with the magnesian fluid. All 
the phosphoric acid is precipitated as triple phos- 
phate. Shake well, and set aside for 24 hours. 
Read off the hight of the settled precipitate in 
the graduated cylinder. 1 cc. of precipitate 
equals .30 grams of phosphoric acid per litre, 
about .60 to .70 grams of phosphate. From this 
calculate the total quantity in 24 hours. 



76 QUANTITATIVE ANALYSIS. 

This method is easy of application, and gives 
results accurate enough for all clinical purposes. 

Volumetric method. Principle, (a) A 
solution of nitrate or acetate of uranium precipi- 
tates all the phosphoric acid from an acidified 
solution of a phosphate as uranium phosphate, 
(b) Potassium ferrocyanide gives a reddish-brown 
precipitate with a uranic salt. This compound 
is therefore used to indicate the termination of 
the reaction. 

Solutions required — 

(1) Solution of uranium acetate.* 
Prepared so that 20 cc.-=0.1 gram phosphoric 

anhydride P 2 5 . 

(2) Solution of sodium acetate. 

Sodium acetate 100 grams. 

Acetic acid 100 cc. 

Distilled water to make 1000 cc. 

(3) Solution of potassium ferrocyanide. 

Potassium ferrocyanide 5 grams. 
Distilled water 100 cc. 
Process, (a) To obtain the total phosphoric 
acid, fill the burette with the uranium solution. 
Add 25 cc. of the urine, 5 cc. of the sodium ace- 
tate solution, and heat to boiling. From the bu- 
rette run in the uranium solution, 1 cc. at a time, 
into the urine kept at the boiling point. After 
each addition stir well and test the mixture by 
placing a drop on a white plate and adding to it 
a drop of the ferrocyanide solution. When a 
brown color appears add 25 cc. more of urine, 
run in uranium solution, 1 cc. less than the 
amount already added, heat to boiling, test a 

* This solution, as all those used in quantitative work, should be 
prepared by a competent chemist, as perfectly pure chemicals and 
accurate weighing are absolutely necessary. 



QUANTITATIVE ANALYSIS. 77 

drop of the mixture with potassium ferrocyanide. 
Continue to add the uranium solution, 0.1 cc. at 
a time, until a drop of the mixture gives with the 
ferrocyanide a faint tinge of color, indicating 
that the precipitation of the phosphates is com- 
plete. Boil the whole mixture again, stirring 
well, and repeat the ferrocyanide test. To be 
accurate two determinations must be made. Read 
off the amount of uranic solution used in the 
titration and calculate the result. Each cc. 
uranic solution=0.005 gram P 2 5 . 

EXAMPLE. 

Urine in 24 hours, 1400 cc. 

Uranic solution used, 22.5 cc. 

50 cc. urine contain 22.5X0.005=0.1125 grams P 2 O s . 

1400 cc. contain 3.1500 grams. 

(b) To estimate the phosphoric acid combined 
with the alkaline earths, make 200 cc. of the fil- 
tered urine alkaline with ammonia and set aside 
for 12 hours. This precipitates the earthy phos- 
phates. Collect the precipitated earthy phos- 
phates on a filter and wash with ammoniacal 
water. Make a hole in the filter and wash the 
precipitate through with water acidified with a 
few drops of acetic acid. Completely dissolve 
the phosphates with the aid of a little acetic acid 
and heat. Add 5 cc. of the sodium acetate solu- 
tion, bring the volume up to 50 cc. with water 
and titrate as in (a). 

In calculating remember that this result gives 
the phosphoric acid in 200 cc. of urine instead of 
50 cc. 

(c) To estimate the phosphoric acid of the 
alkaline phosphates. Subtract the phosphoric 
acid combined as earthy phosphates from the 
total phosphoric acid, and the difference will be 
equal to the acid combined with the alkalis. 



78 QUANTITATIVE ANALYSIS. 

(6) Estimation of Albumin. Of the 

approximate methods of estimating the quantity 
of albumin in the urine, the bulk of the deposit 
after acidulation and boiling is the one most fre- 
quently used by physicians. It serves a useful 
purpose, but is exceedingly inaccurate, and gives 
not even an approximate idea of the percentage 
of albumin. Oliver's method of comparing the 
opacity produced by precipitation of the albumin 
with potassio-mercuric iodide is a very convenient 
clinical method. Ranking far above all other 
approximate methods, both in ease of application 
and accuracy, is Esbach's, with the instrument 
which he terms an albuminometer. As will be 
seen below it can be applied in a moment, and 
the result read off in percentage in a few hours. 

The only accurate method of estimating albu- 
min is the gravimetric, which takes too much 
time to be available to the physician. 

Approximate estimation by boiling. 
Nearly fill a test tube, 6 inches long and f inch 
in diameter, with filtered urine, boil and add a 
few drops of nitric acid. Set aside for 12 hours, 
agitating once or twice in that time to insure 
close deposit of the precipitate. The height of 
the deposit as compared with the column of urine 
— one-half, one-fourth, etc. — is used to indicate 
the amount of albumin. In expressing the 
amount of albumin estimated by this method, the 
terms "one-half deposit," " one-fourth deposit," 
•etc., should be used ; not 50 per cent., 25 per 
cent., etc. 

Oliver's method. Apparatus required. 

(1) A permanent standard of opacity repre- 
senting Iq per cent, of albumin precipitated by 
the mercuric or ferrocyanide tablet or test paper. 



QUANTITATIVE ANALYSIS. 79 

The best form of permanent opacity standard 
is provided by a sealed tube of alumina precipi- 
tated by ammonia. The tube containing the 
alumina must be of the same diameter as the 
tube used for testing. 

(2) A graduated flattened tube of definite di- 
ameter. 

(3) Printed lines 



to determine the depth of the opacity. 

Process. If the urine be highly albuminous 
dilute with one, two or three times its bulk of 
water and multiply the result accordingly. 

Pour 50 minims of the urine — or the diluted 
urine — into the flattened tube. Drop in a mer- 
curic or a ferrocyanide, along with a citric acid 
tablet or test paper, and thoroughly shake the 
tube. Remove the exhausted papers, if test 
papers have been used. Place the card bearing 
the printed lines behind the tube and the opacity 
standard, placed side by side, and if the opales- 
cence of the precipitated albumin is seen to ex- 
ceed that of the standard, add water and shake 
the tube until the two are exactly equalized. 
Add the water with care, 10 minims at a time if 
the opacity only slightly exceeds that of the 
standard. 

When the opacities in the standard and the 
testing tube are equal, calculate the percentage of 
albumin by multiplying the number of minims 
of fluid by two, and pointing off three decimal 
places. For example, when it is necessary to di- 
lute the 50 minims of urine to 230 minims, the 
amount of albumin is .460 per cent. 



80 QUANTITATIVE ANALYSIS. 

.Esbach's method. The albuminometer is a 
tube 1.5 centimeters in diameter and 15 centi- 
meters long, and graduated into lines which 
represent 1 gram of albumin in 1 litre of urine. 
The graduations marked U and R represent the 
amounts of urine and reagent respectively which 
are used in the process. 

The test solution consists of — 

10 grams picric acid (to coagulate the albu- 
min). 
20 grams citric acid (to keep the phosphates 

in solution).' 
Water to make one litre. 

Process. Fill the albuminometer to the mark 
TJ with urine, and to the mark R with the test- 
solution. Mix thoroughly, close the tube with a 
rubber stopper and set aside for 24: hours. Shake 
once or twice in that time to insure deposition of 
the albumin. Read off the result. Each main 
line of division represents 1 gram of albumin to 
1 litre of urine, or .1 per cent. 

Urines very heavily loaded with albumin re- 
quire dilution. If diluted to double its volume 
multiply the result obtained by two, if to three 
times its volume by three, and so on. 

Sherer's method. Place 100 cc. of clear 
urine in a beaker of 200 cc. capacity and acidify 
with a few drops of acetic acid, unless it be 
already markedly acid. Heat in a water bath 
for a half-hour, or until the precipitate settles. 
Collect the precipitate upon a small filter which 
has been dried at 110° F. and weighed. Wash 
the precipitate first with water rendered ammo- 
niacal to remove uric acid and urates, then with 
hot water till the filtrate gives no reaction for 
chlorides, then with alcohol, and lastly with ether. 



QUANTITATIVE ANALYSIS. 81 

Dry the filter and precipitate at 110° F. and 
weigh. The difference in the weight of the filter 
before and after the addition of the precipitate 
equals the albumin in 100 cc. of urine. 

(7) Estimation of Glucose. The most 
convenient way to approximately estimate glucose 
in the urine is by the fermentation method. Dr. 
Roberts' method of determining the amount of 
glucose by the loss in specific gravity after fermen- 
tation, requires no especial apparatus, and gives 
roughly approximate results. Dr. Max Einhorn,* 
of New York, has, however, perfected the fer- 
mentation method, and has made it possible for 
every physician to estimate in a moment's time, 
the quantity of glucose in urine with sufficient 
accuracy for all clinical purposes. The great 
value of the fermentation method lies in the fact 
that it forms an absolute^ confirmative qualita- 
tive test. A number of compounds other than 
glucose reduce the other sugar tests, but none 
respond to fermentation. I have used the method 
for several months with perfect satisfaction. 

The picric acid method of Dr. Geo. Johnson 
is not much easier of application than the accu- 
rate method of Fehling. Some modification of 
Fehling's method is used for all accurate estima- 
tions. Pavy's modification is a favorite with 
many chemists. 

Dr. Roberts' method. Principle. A sac- 
charine urine loses after complete fermentation 
one degree of specific gravity for each grain of 
sugar per fluid ounce. 

Process. Carefully determine the specific 
gravity of the urine. Put 4 ounces in a 12 

* N. Y. Med. Record, Jan. 28, 1887. 



82 



QUANTITATIVE ANALYSIS. 



ounce bottle, add a lamp of yeast as large as a 
walnut (J of a cake of Fleischmann's yeast), shake 
thoroughly, cover with a nicked cork, and set 
aside for 24 hours. Decant the clear urine and 
take the specific gravity. Subtract the specific 
gravity of the urine after fermentation from the 
specific gravity before fermentation. Each de- 
gree of specific gravity lost equals 1 grain of 
sugar per fluid ounce. 
Dr. Max Einhorn's method. 
Principle. The amount of gas (principally 
carbon dioxide) given off 
during the fermentation 
of a solution of glucose 
measures the quantity of 
glucose present. 

Apparatus. The 
"fermentation saccha- 
rometer," (Fig. 3) as the 
instrument is named by 
Dr. Einhorn, consists of 
a U shaped tube, one 
limb of which is a cylin- 
der closed at the top, 
and the other dilated 
into an open bulb. The 
cylinder is graduated 
into cubic centimetres, 
and also marked to per- 
mit the reading of the 
amount of sugar in per- 
centage. The tubes are 
sold in pairs, accompa- 
nied by a test tube grad- 
uated to 10 cc. 

Process. Take 1 gram of fresh commercial 




Fig. 3. Dr. Einhorn's 
Fermentation Saccbarometer. 



QUANTITATIVE ANALYSIS. 83 

compressed yeast (or j\ of a cake of Fleisch- 
mann's yeast), shake thoroughly in the graduated 
test tube with 10 cc. of the urine to be examined. 
Then pour the mixture into the bulb of the sac- 
charometer. By inclining the apparatus the mix- 
ture will easily flow into the cylinder, thereby 
forcing out the air. Atmospheric pressure pre- 
vents it from flowing back. 

Leave the apparatus undisturbed for 20 to 21 
hours in a room of ordinary temperature. 

If the urine contain sugar, the alcoholic fer- 
mentation begins in about 20 to 30 minutes. 
The evolved carbon dioxide gathers on the top 
of the cylinder, forcing the fluid back into the 
bulb. 

On the following day the upper part of the 
cylinder is filled with gas. The changed level 
•of the fluid in the cylinder shows that the sugar 
reaction has taken place, and indicates by the num- 
bers the approximate quantity of sugar present. 

If the urine contain more than 1 per cent, of 
sugar, then it must be diluted with water before 
being tested. 

Diabetic urines of straw color and a specific 
gravity of 1018-1022 may be diluted twice ; of 
1022-1028, five times ; 1028-1038, ten times. 

The original (not diluted) urine contains in 
proportion to the dilution two, Hve or ten times 
more sugar than the diluted urine. 

In carrying out the fermentation test, a normal 
specimen should be tested at the same time. 

The mixture of the normal urine with yeast 
will have on the following day only a small bub- 
ble on the top of the cylinder. That proves at 
once the efficacy and purity of the yeast. 

If there is likewise in the suspected urine a 



84 QUANTITATIVE ANALYSIS. 

small bubble on the top of the cylinder, then no 
sugar is present, but if there is a much larger 
gas volume, then we are sure that the urine con- 
tains sugar. 

Oliver's method with indigo-carmine. In 
making a quantitative test with indigo-carmine 
much more care must be used in every detail than 
in qualitative testing. Select daylight for the 
experiment, and place a white object, as a sheet 
of paper, close behind so that the color changes 
may be accurately noted. Place an open watcli 
on the table. Dissolve an indigo tablet or test 
paper in 60 minims of distilled water in a half- 
inch test tube, and boil the solution till the color- 
ing matter is completely dissolved. Note accu- 
rately the time and add one drop of the urine to 
the boiling indigo solution. Keep the solution 
at the boiling point without agitation, and note 
the color at the end of 30, 60, 90 and 120 seconds. 

(a) The reaction is incomplete. "When the 
final color-change — pale yellow — is not devel- 
oped at the end of two minutes there is less than 
5 grains of glucose per ounce — under 1 per cent. 

If sugar be present in smaller quantity than 5 
grains per ounce, the color of the solution at the 
end of two minutes represents definite quantities 
as follows : 

Yiolet = 1 grain per ounce. 

Purple = 2 grains per ounce. 

Ped = 3 grains per ounce. 

Ped dish-yellow = 4 grains per ounce. 

(b) The reaction is complete. The time 
required for the full development of all the 
colors is determined by the amount of sugar. 
When straw color is reached in — 



QUANTITATIVE ANALYSIS. 



85 



-J minute, there are 35 grains or more per ounce ; 

1 minute, there are 10 grains per ounce ; 

2 minutes, there are 5 grains per ounce. 

This is graphically represented in Dr. Oliver's 
diagram : 



><APg^ 

o § 


o \ 

o ? 1 


i 30 see. w 

\> 


^ 90 sec. 1 

i J 



Urines containing more than 10 grains of 
sugar to the ounce must be diluted one, two, 
three or more times before an accurate estima- 
tion can be made. 

Br. Johnsorts method with Picric Acid. 
Principle. Urine containing glucose boiled 
with picric acid and solution of potassa changes 
to a dark mahogany-red color, due to the devel- 
opment of picramic acid, the intensity of the 
color varying with the amount of glucose. 

To prepare the standard solution. Add 
together in a large boiling tube marked to 1 
drachms, 1 drachm of a solution of glucose, 1 grain 
to the ounce, \ drachm of solution of potassa and 



86 QUANTITATIVE ANALYSIS. 

40 minims saturated solution of picric acid ; dilute 
the whole to 4 drachms. Boil the liquid for 60 
seconds ; a beautiful dark red color develops. 

Cool the tube by cautiously immersing in cold 
water, and if the level of the fluid be below 4 
drachms add water to the 4-drachm mark. 

This color is the standard, and represents 1 
grain of glucose to the ounce four times diluted, 
or, J grain per ounce. The color of this solution 
is not permanent, however. It may be exactly 
imitated by a solution of ferric acetate, prepared 
as follows: 

Solution of iron chloride, sp. grav. 1.44 gi. 
Solution of ammonium acetate, giv. 

Glacial acetic acid, sp. grav. 1.065, giv. 

Mix, and add, 

Solution of ammonia, gi. 

Dilute with distilled water to ,^iv. 

The ingredients are all of the standard of the 
British pharmacopoeia. This solution, corre- 
sponding to \ grain of glucose per ounce, is per- 
manent. 

Process. Test a drachm of the urine as in the 
preparation of the standard solution. Into the 
picro-saccharometer (Fig. 4) — which consists of a 
stoppered tube 12 inches long and f of an inch 
in diameter graduated into 100 equal divi- 
sions, and by the side of this tube and held in 
place by an S-shaped band of metal is a stoppered 
tube of equal diameter and about 6 inches long, 
containing the standard iron solution — pour suf- 
ficient of the dark saccharine liquid to occupy 
exactly 10 divisions of the graduated tube. If 
the color be darker than the standard, cautiously 
dilute with water until they are of the same shade. 

!STote the dilution necessary and calculate the 



QUANTITATIVE ANALYSIS. 



result. If the two agree in color without dilu- 
tion the urine will contain exactly 1 grain per 
ounce. If it be necessary to raise the fluid from 
the 10-mark to the 20-mark to make the colors 
correspond, the urine contains 2 grains per ounce ; 
if to the 35-mark 3.5 grains, etc. 

In the analysis picric acid must be added in 
proportion to the sugar present. If as high as 6 
grains per ounce, 1 drachm of the pi- ^ 
eric acid solution is necessary. If . ^ 
the urine contain more than this quan- 
tity, as determined by the first ex- 
periment, repeat the experiment with 
urine diluted two or more times, as 
may be necessary. In computing the 
result bear in mind the dilution. 

Fehling's Test. Solution. 
Fehling's solution, or the modifica- 
tion in which the copper and the 
Eochelle salt are kept in separate 
solutions, may be used. In the pro- 
cess given below the latter has been 
used. 1 cc. of the solution equals 
.005 gram glucose. 

Process. Measure 5 cc. of each 
of the solutions into a thin white 
porcelain capsule, add 40 cc. of water. Dilute 
10 cc. of urine with 90 cc. of pure water, and 
fill the burette to the zero point with the mixture. 
(This dilution of 10 to 90 is to be made only 
when the urine is highly saccharine ; urines con- 
taining but small quantities of glucose should be 
diluted 10 to 40, or less. The degree of dilution 
is determined by the energy of the reaction in 
the qualitative testing.) 

Heat the copper solution quickly to boiling. 



Fig. 4. 

Dr. Johnson's 

Picro-saccha- 

rometer. 



88 QUANTITATIVE ANALYSIS. 

No change of color should take place in a minute 
or two. (If it do change, reject the solution as 
unfit for use.) Now run the urine mixtur efrom 
the burette into the boiling copper solution, 
quickly at first, then slowly until the blue color 
of the solution is just discharged. To determine 
this point, incline the capsule and observe the 
color against the white porcelain background. 

Now read off the amount of urine used in the 
titration and confirm the accuracy of the obser- 
vation by a second experiment. Accept the 
result of the second experiment. 

EXAMPLE. 

Urine in 24 hours, 2000 cc. 
Urine diluted, 10 cc. urine to 40 cc. water. 

Reading of burette, 26 cc. 
26 
— = 5.2 cc. urine contain .050 gram glucose. 

5.2 : .05 :: 2000 : 19.9 grams in 24 hours. 

Pavtfs method. Dr. Pavy avoids the trou- 
blesome precipitation of cuprous oxide by em- 
ploying an ammoniacal copper solution, the am- 
monia of which holds the oxide in solution. 

Process. Place in a 5 or 6 ounce flask 10 cc. 
of the copper solution. Provide the flask with a 
cork having two perforations, through one of 
which passes the point of a Mohr's burette, the 
other being fitted with a short glass tube to carry 
off the ammoniacal vapors. (An open flask can- 
not be used in this experiment, since oxygen ab- 
sorbed from the air will vitiate the result.) 

Dilute the urine 1 to 10, 1 to 20, or 1 to 40, 
according to the amount of sugar present, as ap- 
proximately determined by the qualitative tests. 
It should be diluted so that 4 to 8 cc. of the 
mixture will reduce the copper solution. Fill 
the burette with the diluted urine. 



QUANTITATIVE ANALYSIS. 89 

Heat the contents of the flask to boiling, and 
run in the urine from the burette. Reduce the 
flow as the reaction reaches an end, which is an- 
nounced by the complete disappearance of the 
blue color. 

Take the burette reading and calculate the re- 
sult. 

1 cc. Pavy's solution=.0005 glucose. 

The 10 cc. used in the titration=.005 glucose. 

Determine the result as in the use of Fehling's 
solution. 

(8) Estimation of Bile-Salts by Dr. 

Oliver's method. A permanent standard of opa- 
city is required to represent the average dis- 
charge of bile-salts in healthy urine. Dr. Oliver 
uses a standard made by a precipitate of alumina 
in a sealed tube. A standard may be extempo- 
raneously prepared by mixing together 60 minims 
(4 cc.) each of healthy urine, reduced to specific 
gravity of 1008, and of the peptone test solution. 

Process. To 60 minims of the peptone test 
solution, the urine of sp. gr. 1008 is added — in 
ordinary cases 10 or 20 minims at a time, and 
allowing a minute to elapse after each addition — 
until the opacity induced is seen to be exactly 
equal to, or to slightly overstep, that of the stan- 
dard — the tubes being held to the light, shaded 
by a dark background, such as that of the coat- 
sleeve. 

If 50 or 60 minims of the urine bring up the 
opacity merely to that of the standard, the pro- 
portion of bile-salts is not outside the normal 
range — in the direction of increase. But any 
smaller quantity of urine required indicates an 
excess of the biliary derivatives over the physio- 



90 QUANTITATIVE ANALYSIS. 

logical variations. The smaller the amount of 
urine needed, the larger the proportion of bile- 
salts present — according to the following table* : 





Percentage increase of bile- 


Minims of urine 


salts over the normal 


required. 


standard. 


55 


5 


50 


10 


45 


17 


40 


25 


35 


36 


30 


50 


25 


70 


20 


100 


15 


150 


10 


250 


5 


550 


4 


700 


3 


950 


2 


1,450 


1 


2,950 



•^Calculated expressly for this work. The figures given in Oliver's 
Bedside Urine Testing are wide of the truth. 



OHAPTEE III. 



MICROSCOPICAL EXAMINATION. 

Perfectly normal urine, at the time of evacua- 
tion and for some hours after, contains all of its 
constituents in solution. A light cloudy deposit 
after a few hours is normal. It consists of mucus 
entangling a few epithelial cells. After from 
twelve to twenty-four hours, the time depending 
upon the temperature, the changes described in 
Part 1, and known as the acid and alkaline 
fermentations take place. By these fermenta- 
tions the chemical characters of the constituents 
of the urine are so changed that precipitation of 
various compounds takes place. During. the acid 
fermentation, acid sodium and potassium urates 
and uric acid deposit; during the alkaline fer- 
mentation, ammonium urate, amorphous calcium 
phosphate and triple phosphate. On account of 
the liability of these changes to occur deposits 
should be examined early. 

To examine a deposit, put an ounce or two of 
the urine in a cylindrical vessel, a test tube on 
foot or a cylindrical graduate, and set aside in a 
moderately cool place for a few hours. 

In general we may expect to find in an acid 
urine, urates, uric acid, tyrosin, cystin ; in an 
alkaline urine, ammonium urate, calcium phos- 
phate, triple phosphate, calcium carbonate ; in a 
nearly neutral urine, calcium oxalate. Organized 
sediments may occur in acid, neutral or alkaline 
urines. 



92 MICROSCOPICAL EXAMINATION. 

Take up a few drops of the sediment in a 
nipple pipette and deposit a drop of it on a clean 
glass slide, and drop over it a thin cover glass. 
If the sediment be very light concentrate it by 
taking the lower stratum from the cylinder and 
allowing it to settle again in a small test tube. 
Concentration can be very neatly done also by 
taking the sediment up in a nipple pipette and 
setting that aside. When searching for casts add 
to the drop of urine a drop of a nuclear staining 
fluid, as ammonio-carmine, and set aside for a few 
minutes. The casts and epithelium take the 
stain and contrast strongly with the unstained 
crystals and other objects. Without staining 
delicate hyaline casts often escape detection. As 
a further aid in identifying doubtful objects, 
have the object in view under the microscope 
and move the cover glass very gently with the 
tips of the fingers or with the point of a dissect- 
ing needle. By this little manoeuvre the shape 
and all sides of an object may be subjected to 
scrutiny. Examine the sediment with a -J-inch 
or a J-inch objective. The J-inch or higher is 
often necessary to resolve small crystals. 

Classification. Deposits may be classi- 
fied into 

The unorganized — 
Uric acid ; 

f Acid sodium urate ; 

TT Acid potassium urate ; 

urates \ * . , r -, . , 

J Acid calcium urate ; 

[_ Acid ammonium urate ; 

Calcium oxalate; 

Ammonio-magnesian phosphate ; 

Calcium phosphate ; 



MICROSCOPICAL EXAMINATION. 



93 



Calcium" carbonate ; 
Tyrosin ; 
Leucin ; 
Cystin ; 
Oil globules. 
The organized — 
Epithelium ; 
Mucus ; 
Pus; 
Blood ; 
Casts ; 

Spermatozoa ; 
Microbes ; 
Elements of morbid growths. 



UNORGANIZED DEPOSITS. 



Uric Acid. 

Uric acid 
forms. (Fig. 5. 



assumes a 



Microscopical characters. 
multitude of crystalline 
The most frequently observed 




Fig. 5. Uric Aoid. X120. 

forms are rhombic, often with two obtuse angles 
rounded. Whetstone or lozenge shaped, dumb 
bell and comb-shaped crystals are common. The 
crystals may be very minute in size, or large 
enough to be easily visible with the naked eye. 



94 MICROSCOPICAL EXAMINATION. 

When of large size they form the "red pepper" 
grains or gravel so often spoken of by patients. 
These large grains are made up of rosette-shaped 
masses of crystals. Uric acid is nearly always 
colored from light yellow to dark red. Every 
red, brown, or yellow crystalline deposit is uric 
acid. 

Chemical characters. Insoluble in hot or 
cold water. Soluble in alkalies. Responds to 
the murexid test. 

Murexid test. Place a few grains of uric 
acid on a porcelain plate, add a few drops of 
nitric acid, and heat gently until the fluid has all 
evaporated. Moisten the yellow residue which 
results with a drop of ammonia. A beautiful 
purple red color appears, due to the formation 
of ammonium purpurate C 8 H 4 (]SrE[ 4 )]^~ 2 6 . 

Occurrence. The urine of healthy persons 
often deposits uric acid 10 or 20 hours after emis- 
sion. Such an event is normal. A deposit 
formed 3 or 4 hours after passing is not normal. 
Persons otherwise healthy not infrequently pass 
urine which shows a deposit. Slight disturbances 
of the chemistry of the body not manifested by 
symptoms may determine it. When occasional 
and transient the occurrence is of no consequence; 
when persistent it requires treatment. A highly 
acid state of the urine is most influential in pro- 
ducing the precipitate, the acid of the urine de- 
composing the soluble neutral urates and liberat- 
ing the very insoluble uric acid. A deposit of 
uric acid does not always mean excess. Changed 
chemical characters in the urine may determine 
a deposit when the amount of uric acid is below 
normal. The significance of the various forms 
of crystals is as yet unknown. The pathological 



MICROSCOPICAL EXAMINATION. 



95 



conditions in which uric acid deposits are fre- 
quent are — 

Convalescence from febrile diseases ; 

Chronic pulmonary diseases ; 

Pneumonia ; 

Acute rheumatism ; 

Chorea ; 

Functional and organic liver diseases ; 

Acute inflammation of the kidneys ; 

Eczema and some other skin diseases ; 

Gout; 

Diabetes ; 

Lithaemia. 
Urates. Uric acid occurs in the urine in com- 
bination with sodium, 
potassium and ammo- 
nium, rarely with cal- 
cium. The urates form 
a bulky, sometimes col- 
orless, often yellow or 
red deposit. It is often 
termed a " brick-dust " 
or "lateritious" sedi- 
ment. 

Microscopical characters. Sodium urate 
forms an amorphous deposit, composed of minute 
particles which show no crystalline form even 
under high powers. The particles are massed 
together in groups often assuming various forms. 
Rolled masses of urates sometimes resemble 
casts. Sodium urate sometimes crystallizes in 
prisms arranged in rosettes or stellate bundles. 
Potassium urate closely resembles the sodium 
salt. Ammonium urate occurs only in alka- 
line urines. It appears in the form of dark 




Fig. 6. Crystalline and Amor- 
phous Urates . X200. 



96 MICROSCOPICAL EXAMINATION. 

spheres and globular masses, the spheres often 
being armed with little spicules. (Fig. 6.) 

Chemical characters. Urates are soluble in 
hot water, so that any deposit that disappears on 
the application of heat is composed of urates. 
They respond to the murexid test. 

Calcium Oxalate. Oxalic acid in very 
minute quantity in combination with sodium and 
ammonium is a constant constituent of all urines. 
Under several physiological and pathological cir- 
cumstances it appears as the insoluble calcium 
^s> oxalate and forms one of 

® <cP ^ ^ e urmai T sediments. It 
jp ^ € i^, Q may be found in acid, neu- 
s IMf tral or alkaline urines. 

Microscopical charac- 
ters. The deposit most 
» ^ frequently occurs in the 
f# 1§| ™ form of very minute octa- 

Fig. 7. Calcium Oxalate. hedra - The J appear aS 1111- 

(After Charles.) X250. nute squares with two lines 
crossing each other in the centre — letter-envelope 
shape. When very minute they merely show a 
bright spot in the centre. Dumb-bell forms are 
sometimes seen, and modifications of dumb-bells, 
as peculiarly marked o voids. (Fig. 7) 

Chemical characters. Insoluble in acetic 
acid (distinguishing from triple phosphate), alco- 
hol, water, and alkalies. Soluble in nitric acid. 

Significance. Calcium oxalate may be de- 
rived (Ralfe) — 

(1) From the food. 

Directly by the ingestion of foods contain- 
ing calcium oxalate, as rhubarb, sorrel, 
tomatoes, excess of carbonated drinks, etc.; 



MICROSCOPICAL EXAMINATION. 9T 

indirectly, by the imperfect oxidation of 
carbohydrates and fats, oxalic acid being 
one of the substances formed. 

(2) From increased tissue metabolism. 
Imperfect oxidation of fats, etc., is the cause 

of the appearance of the oxalate. Urines 
under these circumstances are high col- 
ored, and contain excess of urea, uric acid 
and phosphates. This is one of the most 
frequent pathological causes of a deposit. 

(3) From the mucus from the urinary tract. 
Meckel is of the opinion that the acid fer- 
mentation which mucus undergoes in cer- 
tain catarrhal conditions gives rise to oxa- 
late of calcium. 

(4) From excess of acid in the circulation. 
This condition is found in catarrhal inflam- 
mation of the small intestines. Ferment- 
ative changes generate the fatty acids in 
great excess, which are absorbed and but 
incompletely oxidized, and the interme- 
diate acid, oxalic, is formed. This condi- 
tion, often described under the term oxal- 
uria, is attended by all the symptoms of 
intestinal indigestion, by irritation of the 
bladder from the presence of the sharp 
pointed crystals, and by great mental de- 
pression. 

According to Beale, a deposit of dumb-bells of 
calcium oxalate is of peculiar significance. They 
are very liable to form the nuclei of calculi. 
When the oxalate assumes this form, energetic 
efforts should be made to keep it in solution. 

Phosphates. The phosphates in the urine 
are held in solution by the acid present. So soon 

7 



98 MICROSCOPICAL EXAMINATION. 

as the urine becomes neutral or alkaline, whether 
the alkalinity be due to fixed or volatile alkali, 
the phosphates are thrown from solution and ap- 
pear as a deposit ; and this deposit takes place 
whether the phosphates are increased or dimin- 
ished. A deposit of phosphates, then, has no 
necessary relation to the amount. The great 
excess found in phosphaturia does not show itself 
by a deposit unless the urine becomes neutral or 
alkaline. 

Calcium Phosphate usually appears as a 
white deposit in urines neutral or alkaline from 
either fixed or volatile alkali. 

Microscopical characters. The deposit is 
amorphous or crystalline. The amorphous gran- 
ules are distinguished 
from a similar deposit of 
urates by the particles be- 
ing isolated and scattered 
evenly over the field, 
while the particles of a 
deposit of amorphous 
urates adhere together 
and form masses of vari- 
Fig. 8. Ammonio-Magnesian ous shapes. The crystals 
Phosphate. X120. f ca ] c i lim phosphate are 

wedge-shaped and arranged in rosettes, their 
points uniting. 

Chemical characters. The deposit is in- 
creased by heat and dissolved by acids, distin- 
guishing it from a deposit of urates. 

Ammonio-magnesian phosphate — (triple 
phosphate) N H 4 'Mg P 4 , occurs in urines neu- 
tral or alkaline from the presence of volatile 
alkali (ammonia). 

Microscopical characters. The most com- 




MICROSCOPICAL EXAMINATION. 



99 



moil form is the triangular prism with obliquely 
truncated ends (Fig. 8). Modifications of this 
form and imperfect crystals are frequently seen. 
Sometimes beautiful stellate feathery crystals are 
observed ; they may be artificially produced by 
adding ammonia to fresh urine. 

Chemical characters are the same as those of 
calcium phosphate. 

Occurrence. As has been said before, a de- 
posit of the phosphates is indicative of a neutral 
or alkaline reaction of the urine rather than an 
excess of phosphates, and the significance of a 




Fig. 9. Leucin and Tyrosin. X255. 

deposit will depend upon the cause, persistence, 
etc., of the alkalinity. It should be borne in 
mind that although no conclusion can be drawn 
from an excess of phosphates, the frequent pre- 
sence of a deposit is of significance on account of 
a possibility of the formation of soft phosphatic 
concretions. 

Calcium Carbonate, a very rare de- 
posit, occurs as small spheres. It effervesces on 
the addition of an acid. 

Tyrosin and Leucin. Microscopic 

Characters. Tyrosin appears as fine, long, 



100 MICROSCOPICAL EXAMINATION. 

silky needles, generally arranged in sheaf-like 
bundles or rosettes. It sometimes appears as yel- 
lowish-green, crystalline globules, which dissolve 
in hot ammonia, and recrystallize on cooling in 
radiated groups of needles. Leucin appears as 
brown-tinted spherical masses, with fine radial 
striation and often with the appearance of con- 
centric rings. (Fig. 9.) 

Cy still. Microscopical characters. Cys- 
tin appears as hexagonal plates, colorless or some- 
times pigmented. It is soluble in ammonia, re- 
crystallizing on evaporation. (Fig. 10.) 

Occurrence. Dr. Bence Jones thinks cystin 
is constantly formed in the healthy organism and 

. immediately transformed into 

N4ct ® sulphuric acid, carbon dioxide 

£j / V^%> and urea. Whenever this 

O/*^ \y^ transformation is arrested cys- 

© ^ ■Br-»^5 ^ m appears in the urine. It 

O 1 ^^"^* is a very rare sediment. In 
>/^lfe * ne ma j 01 *ity °f ^ ne cases in 
QK [^Sm^^ which it has been found the 
^^ ^jrP^ individuals have been below 
Fig. io. oystin. x2oo. t } ie standard in health. A 
number of cases have been observed in which a 
deposit of cystin persisted for years. Dr. Ralfe 
has met with it in the urine of strumous children, 
and adults with hepatic disease. 

Oil Globules in the urine appear under 
the microscope as highly refractive spheres and 
minute bright specks. They are soluble in ether. 

ORGANIZED SEDIMENTS. 

Epithelium (Fig. 11) from various parts 
of the urinary tract, from glands opening into itj, 



MICROSCOPICAL EXAMINATION. 101 

and, in women, from the vagina, frequently occur 
in urinary deposits, both in health and disease. 
In disease the appearance of the cells and their 
number may give important information as to 
the nature, location and severity of the morbid 
process. The varieties of epithelial cells that are 
to be seen are — 

Round cells ; 

Columnar cells ; 

Flat cells. 
Round cells. Small round cells come from 
the convoluted tubes of the kidney. (Fig. 14-A, 
1.) Large round cells come from the pelvis of 




Fig. 11. a From ureter, b From urethra, c From pelvis of kidney 
d From bladder, e From vagina. X150. 

the kidneys, and fundus of the bladder. They 
are irregularly round, granular, and contain a 
large single nucleus. 

Columnar cells may come from the pelvis, 
ureters (often spindle shaped), fundus of the blad- 
der and urethra. They are elongated, irregularly 
conical, and contain a single nucleus. 

Flat cells are derived from the base of the 
bladder and from the vagina. The vaginal cells 
are much the larger. 

Although in many instances it is possible to 
locate the source of the epithelium, the great 
similarity of the cells from different localities 
renders it often a matter of guess work. 



102 MICROSCOPICAL EXAMINATION. 

The epithelium may, under different circum- 
stances, undergo granular or fatty degeneration, 
maceration and disintegration, or they may be 
imperfectly formed. 

Abundant epithelium means catarrhal inflam- 
mation. 

Mucus and Pus. Mucus in small quan- 
tity is present in normal urine. It forms a light 
sediment near the bottom of the glass, which is 
visible because of the epithelium, 
® ® ® ™ crystals, etc., entangled in it. In 
® iTL L a disease it may be present in large 
@® © quantity, and it then appears as a 

G\ @ '® (S) clear, translucent mass. 
@) ® i) ^ Pus may be present in the 
Fig 12 Pus urine in very small amount, or in 
a Pus eeiis in neu- large quantity ; it then forms a 

tral fluid, b Pus , ft ^ ", ., •',' -x. mi 

cells acted upon by bulky white deposit. Ihe urine 

acetic acid). X200. ig turbid when pagsedj m d the 

pus quickly deposits. 

Microscopical characters. Pns and mucus 
corpuscles have the same appearance under the 
microscope. (Fig. 12.) They appear as small 
granular globules, -gVoir to ^"sVtt mcn i n diameter, 
and may vary somewhat in shape and character in 
different states of the urine. Acted upon by 
acetic acid, the granular appearance is destroyed, 
and they become clear cells with one or more 
distinctly visible nuclei. Abundant epithelium, 
croupous shreds and crystals often accompany pus 
deposits. 

Chemical character. The mucin of mucus 
is precipitated by acetic acid. The pyin of pus 
is precipitated by mercuric chloride. These re- 
actions serve to distinguish between these bodies. 



MICROSCOPICAL EXAMINATION. 103 

When present together the pyin may be precipi- 
tated by mercuric chloride and filtered out, and 
the filtrate tested for mucin by acetic acid. 

Donne's test for pus. To the suspected de- 
posit obtained by decanting off the snpernatent 
fluid add a little liquor potassse. The corpuscles 
quickly disappear and the pus is transformed into 
a thick, glairy, gelatinous mass. Mucus treated 
with liquor potassse becomes thinner. 

This change in pus takes place spontaneously 
in urine that has undergone alkaline fermenta- 
tion, the ammonia formed in the decomposition 
acting as the reagent. Pus changed in this 
manner must not be mistaken for mucus. 
Occurrence. Pus is present in the urine — 
In inflammation from any cause, at any point 

along the urinary tract ; 
In inflammation of glands and ducts opening 

into the urethra ; 
In some forms of Bright' s disease ; 
In renal embolism and abscess ; 
In abscesses opening into the urinary tract 

at any point ; 
From sources outside the urinary tract, as 
the admixture of a leucorrhoeal discharge 
in women. 
Pus coming from the urethra is more abundant 
at the beginning of urination ; from the bladder, 
at the end of the act. 

Urine containing pus coming from the kidney 
is usually acid ; from the bladder the reaction is 
usually alkaline. 

If blood accompany the pus the two are inti- 
mately mixed when the trouble is in the bladder ; 
when in the kidney the blood forms a layer on 
top. 




104 MICROSCOPICAL EXAMINATION. 

Urine containing pus in any quantity is albu- 
minous. It is a question often very difficult to 
decide whether the albumin in a purulent speci- 
men is derived entirely from the liquor puris or 
comes in part from a diseased kidney. The 
amount of albumin which is to be expected from 
the pus present is gradually learned by observa- 
tion, and this point alone enables an experienced 
observer to reach a conclusion. Other characters 
of the urine, as the presence 
or absence of casts, and the 
amount of urea, offer valuable 
evidence. 

Blood. Blood corpuscles 
are distinguished by their char- 
Fig " 13 cies B1 °x2oo orpus " acteristic bi-concave centers 

a Red cells seen flat. ail( J yellowish Color. In dilute 
» In rouleau, c In pro- • ,1 t n -i i 

file, d crenated. e urine tiie discs swell up and be- 
white ceils. come roun( j. [ n concentrated 

urine they shrink and become crenated. (Fig. 
13.) 

Tube casts. In diseases of the kidney, 
manifested by albuminuria, casts of the uriniferous 
tubules find their way into the urine, and can be 
seen with the microscope in the sediment. In 
some cases they are very numerous, every slide 
examined showing many specimens ; or they may 
be so few that the most diligent search is neces- 
sary to discover them. Whenever they are to be 
sought in a scanty sediment it should be concen- 
trated by allowing it to settle two or more times. 
To take the sediment up from the settling glass 
in a nipple pipette, and allow it to collect in the 
end ol that is a very efficient way to concentrate. 



MICROSCOPICAL EXAMINATION. 105 

Casts are formed of eoagulable material, ex- 
uded into the lumen of the uriniferous tubules. 
This solidifies and entangles with it any other 
substances, as blood, pus, epithelium, etc., that 
may be present in the tubule. The casts contract 
and loosen from the sides of the tubule, and are 
washed into the pelvis of the kidney by the urine 
secreted above them. 

The nature and origin of the eoagulable mate- 
rial that forms the base of the cast is still a mat- 
ter of dispute. The conditions under which the 
casts are formed admit of several explanations, 
and it is probable that in different pathological 
conditions of the tubules one of two or more pro- 
cesses is active, or perhaps two or more combine. 

They are probably for the most part of the na- 
ture of fibrinous exudations. In the acute forms 
of Bright's disease, particularly, the conditions 
for fibrin formation are present. The exuded 
plasma contains the fibrinogen, and the white cor- 
puscles the globulin and ferment. Brought in 
contact with the diseased epithelium the white 
cells disintegrate and fibrin is formed. 

Beale thinks that casts are composed of a sub- 
stance nearly related to mucin, and that it is 
formed by the protoplasm of the tubes, which 
under ordinary circumstances forms the outer 
part of the epithelial cells. Under the condi- 
tions of renal congestion and inflammation, how- 
ever, it forms the transparent material of the cast. 

Again, casts may be the result of coagulation 
necrosis of the lining epithelium of the tubules. 
Casts having such a source do not differ in com- 
position from the proper fibrinous ones ; the 
fibrinogen has the same source, while the epithe- 



106 MICROSCOPICAL EXAMINATION. 

Hum, instead of the white blood cells, furnish the 
fibrin oplastic matter and the ferment (Coats). 

Cornil recognizes mucous tube-casts which dif- 
fer from the ordinary hyaline casts in being more 
delicate and transparent and with less clearly 
defined borders. A still more important distinc- 
tion is that they are not stained by carmine. I 
have observed these casts in cases of albuminuria 
after specific fevers. This difference in chemical 
properties makes it highly probable that the 
transparent base of tube-casts varies in composi- 
tion. 

Varieties. Hyaline, or transparent casts 
(fibrin cylinders), are the most common form, 
and are observed in all varieties of renal disease. 
They are mostly long and narrow cylinders, trans- 
parent and homogeneous. They may be straight, 
wavy or forked. Their ends may be rounded off 
or have the appearance of having been broken. 
They often have a few particles or streaks of 
granular matter imbedded in them. 

Hyaline casts vary from xuVo" to -^J-g- inch in 
diameter. The small hyaline casts are formed in 
tubes the epithelium of which is firmly attached 
to the basement membrane. They have the di- 
ameter of the normal calibre of the tubule. The 
large casts are formed in tubes denuded of epithe- 
lium by disease. Their diameter is therefore 
equal to the diameter of the tube measured from 
the basement membrane. Some hyaline casts are 
more highly refractive and dense, and have the 
appearance of molten wax. These are termed 
waxy casts, and have been observed particularly 
in amyloid disease of the kidney. They do not 
respond to the test for amyloid substance. Some 



MICROSCOPICAL EXAMINATION. 



107 



hyaline casts are not stained by carmine (the 
mucous casts of Cornil). (Fig. 14.) 

Blood casts. In diseased conditions attended 
by the effusion of blood into the tubules casts 
are formed containing few or many blood discs. 
Often the cast appears to be a solid mass of cor- 
puscles, and is in reality a miniature clot. 




Fig. 14. Renal Casts (Charles). X2i5. 

A. Renal Casts— 1 Epithelial casts. 2 Granular casts (the upper- 
most containing blood cells). 3 Large and small hyaline casts. 
4 Fatty casts. S w 

B. Renal Cells— a Normal, b Undergoing fatty degeneration. 
e Free fat granules. 

C. Objects that may simulate renal casts— 1 Mucus cast. 2 Sper- 
matic cast. 3 Human hair. 4 Woolen hair. 5 Flax. 6 Cotton fibres. 

Epithelial casts are formed when the epi- 
thelium exfoliates and becomes entangled in the 
coagulating material. The epithelial cells may 
be fairly perfect, or may have undergone granu- 
lar or fatty degeneration. 

Granular casts result from the imbedding 



108 MICROSCOPICAL EXAMINATION. 

of granular matter in a forming cast. The gran- 
ular matter may be the debris of degenerating 
epithelium or disintegrating blood cells, molecu- 
lar fat, or amorphous urinary salts. They are 
termed highly, moderately, or faintly granular, 
according to the amount of granular matter 
present. 

Fatty casts show minute oil globules scat- 
tered through the hyaline substance. 

Pus casts have also been observed. 

Sometimes crystals of various salts are seen 
imbedded in casts, or a small cast may be formed 
inclosed by a larger one. 

Clinical significance. Casts are usually in- 
dicative of congested and inflammatory condi- 
tions of the kidney. They are found in — 
Acute and chronic renal congestion ; 
Acute Bright's disease ; 
Chronic Bright's disease ; 
Irritation from renal calculi ; 
The urine of jaundice without renal disease. 

If Beale's theory of the production of the base 
of casts be true, it is highly probable that hyaline 
casts may be formed during transient and insig- 
nificant catarrhal states of the renal tubules, in- 
duced by diatetic errors, exposure, or medicines, 
and not incompatible with a state of apparent 
health ; and in fact they are occasionally observed 
in the urine of healthy individuals. Bat, although 
they may be found under such circumstances, 
their occurrence in a urinary deposit is a matter 
of gravity, and with but few exceptions indicates 
disease of the kidney. 

In addition to the value of the discovery of 
casts as indicative of renal disease, their number 
and appearance in a given case furnish most 



MICROSCOPICAL EXAMINATION. 109 

valuable assistance iu the determination of the 
condition of the kidney, the prognosis, and the 
plan of treatment to be pursued. The number 
of casts often bears no relation to the gravity of 
the case. For example, in the declining stage of 
acute nephritis they are often very abundant, 
while in grave interstitial nephritis only an occa- 
sional specimen may be found. Casts usually 
accompany albuminuria, but they have been ob- 
served without this symptom. Casts without 
albumin are probably rarer than is thought. 
Delicate and careful testing would, I think, almost 
always reveal it. Casts formed in non-albumin- 
ous urine are always hyaline. Albuminuria may 
occur without casts. 

Hyaline casts may be seen in congestion of 
the kidney from any cause, and in mild and 
transient catarrhal states. They also may be 
present alone or in company with other varieties 
in all forms of acute and chronic Bright's disease. 
They are often seen in the latter stages of acute 
nephritis. They are about the only form ob- 
served in interstitial nephritis and amyloid kid- 
ney before the involvement of the tubules in 
the morbid proccess. In chronic nephritis they 
are also frequent. The small hyaline casts are 
seen when the epithelium is intact; the large 
casts when the epithelium is denuded. The 
latter are, then, in chrouic disease, of much graver 
significance, indicating destruction of the secret- 
ing tissues. When observed in the latter part of 
acute nephritis the injury to the epithelium is 
often but temporary, and they are not so ominous. 

Blood casts are significant of hemorrhage 
into the tubules, which may occur in intense 
arterial or venous congestion or acute nephritis. 



110 MICROSCOPICAL EXAMINATION. 

Epithelial casts are particularly indicative 
of the early stages of nephritis. The condition 
of the epithelium making up the casts is signifi- 
cant of the changes that the tubules have under- 
gone. 

Granular casts. The nature of the granular 
matter making up these casts varies much, and 
the appearance of attendant varieties of casts 
gives valuable data for determining its source. 
In the later stages of nephritis the granular mat- 
ter is usually the debris of degenerated epithe- 
lium. In fatty kidney it consists of molecular 
fat. Under other conditions amorphous urinary 
salts may give the granular appearance. 

Fatty casts are found during convalescence 
from acute nephritis, in fatty kidney, and under 
other circumstances. When highly fatty casts 
are persistent grave fatty change is indicated. 

Pus casts indicate the presence of pus in the 
tubules from bursting of an abscess or pus form- 
ation from the inflamed epithelium. 

Spermatozoa may be recognized under a 
I inch objective by their characteristic oval head 
or body and the delicate tail-like cilia projecting 
from it. In urine they are motionless. They 
are found in urine under the various physio- 
logical and pathological conditions in which they 
are discharged into the urethra. 

Microbes. In addition to the micrococcus 
ureas always present in decomposing urine, vari- 
ous other minute organisms may be found. 
Although of biological interest they, with one 
exception, have no clinical significance. The 
Saccharomyces u rinse is found only in urine con- 
taining sugar. 



MICROSCOPICAL EXAMINATION". Ill 

Elements of Morbid Growth*. 

Tumors of the bladder often reveal themselves 
by the appearance of minute parts of them or 
their individual cells in the urine. It is unneces- 
sary to detail here the microscopical characters 
of such a deposit. 



CHAPTEE IV. 



ANALYSIS OF CALCULI. 

Urinary calculi occasionally consist of but one 
constituent. Most frequently, however, they 
consist of two or more, arranged in concentric 
layers around a nucleus composed of a small renal 
calculus, mass of mucus or epithelium, a clot of 
blood or a foreign body. A small concretion of 
uric acid is the most frequent nucleus. 

Of the compounds that go to make up urinary 
calculi the most important are — 

Uric acid and urates ; Calcium oxalate ; 

Earthy phosphates ; Xanthin ; 

Calcium carbonate ; Cystin. 

fteneral characters of calculi. 

Uric acid calculi are the most frequent, form- 
ing about 25 per cent, of all stones. They are 
hard, usually of a flattened ovoid shape, reddish 
or yellowish brown in color. The surface is 
smooth and concentric, layers crystalline in 
structure. 

Urates are almost always combined with other 
compounds. Ammonium urate calculi are some- 
times seen in children. They differ only in color 
from uric acid calculi, being of a dull white or 
clay color. 

Calcium oxalate calculi are common, form- 
ing about 20 per cent, of all stones. They usu- 
ally form around a uric acid nucleus. They are 
often quite large, have a very rough and irregu- 



ANALYSIS OF CALCULI. 113 

lar surface, and are brownish or dirty purple in 
color. From these properties they are often 
termed " mulberry calculiP Small, smooth 
and often polished calcium oxalate calculi are 
often met with — hemp seed calculi. Many 
mixed calculi contain this salt. 

Phosphates. Calcium phosphate forms a 
very rare calculus. They are often large, with 
white, friable exterior. 

Ammonio-magnesian phosphate is very rarely 
the sole constituent of a stone. It often forms 
layers of mixed calculi, and in combination with 
calcium phosphate forms what is termed the fu- 
sible calculus. 

Calcium carbonate calculi are occasionally met 
with. They are usually multiple. They are 
spherical, sometimes pyramidal in shape, and 
mostly white in color. 

Xanthin calculi are extremely rare. They 
are yellowish brown in color, smooth, and take a 
polish when rubbed. 

Cystin calculi are very rare. They are 
smooth, greenish-yellow in color, and very soft. 

Concretions of fibrin, blood, fatty substance or 
cholestrin are sometimes seen. 

To analyze a calculus. Make a sec- 
tion through the centre of the stone, and scrape 
off some of the cut surfaces. If the stone be 
small pulverize it. Make separate analysis of the 
body of the stone and the nucleus. 

Examine the powder thus obtained by 

WITTHAUS' SCHEME FOR ANALYSIS. 

1. Heat a portion on platinum foil: 

a. It is entirely volatile 2 

b. A residue remains 5 



114: ANALYSIS OF CALCULI. 

2. Moisten a portion with nitric acid, evaporate to dry 
ness at low heat; add ammonium hydrate: 

a. A red color is produced 3 

b. No red color is produced 4 

3. Treat a portion with potassium hydrate without heat- 
ing: 

a. An ammoniacal odor is observed 

Ammonium urate. 

b. No ammoniacal odor Uric acid. 

4. a. The nitric acid solution becomes yellow when 

evaporated; the yellow residue becomes red- 
dish-yellow on addition of potassium hydrate, 
and, on heating with potassium hydrate, 

violet-red Xanthin. 

b. The nitric acid solution becomes dark brown 
on evaporation Cystin. 

5. Moisten a portion with nitric acid; evaporate to dry- 
ness at low heat; add ammonium hydrate: 

a. A red color is produced 6 

b. No red color is produced 9 

8. Heat before the blow-pipe on platinum foil: 

a. Fuses 7 

b. Does not fuse 8 

I. Bring into blue flame on platinum wire: 

a. Colors flame yellow Sodium urate. 

b. Colors flame violet Potassium urate. 

8. The residue from 6: 

a. Dissolves in dilute hydrochloric acid with effer- 

vescence ; the solution forms a white ppt: 
with ammonium oxalate Calcium urate. 

b. Dissolves with slight effervescence in dil. sul- 

phuric acid; the solution, neutralized with 
ammonium hydrate, gives a white ppt. with 

hydrogen disodium phosphate 

Magnesium urate. 

9. Heat before the blow-pipe on platinum foil: 

a. It fuses Ammonio-magnesian phosphate. 

b. It does not fuse 10 

10. The residue from 9, when moistened with water, is: 

a. Alkaline 11 

b. Not alkaline Tricalcic phosphate. 

II. The original substance dissolves in hydrochloric acid : 

a. With effervescence ... Calcium carbonate. 

b. Without effervescence. . . Calcium oxalate. 

Note.— A. fresh portion of the powdered calculus is to he taken 
for each operation except where otherwise stated. 



CHAPTER V. 



APPARATUS AND REAGENTS. 

In this chapter will be enumerated the appa- 
ratus and reagents that are necessary to conduct 
the tests detailed in the body of the book, and 
which could not be conveniently spoken of in the 
text. 

Apparatus. Test tubes. A dozen test 
tubes of assorted sizes with rack and drainer 
are necessary. For general testing, 
a test tube -£ inch in diameter and 
3 inches long is the most conven- 
ient. A large tube for boiling is 
useful. Test tubes on foot form 
the best vessels for the collection 
of sediment. One or more gradu- 
ated -test tubes are very convenient. 

Pipettes. The nipple pipette 
(Fig. 15) is the most useful for all 
the manipulations in urine analysis. 
They may be obtained in various 
sizes and graduated into minims or 
cubic centimetres. The ordinary 
medicine dropper answers well 
when specially made instruments 
cannot be obtained. Yolume pi- Fig. 15. 
pettes (Fig. 16) holding 5 cc. and Ni PP le ^pette. 
10 cc. are used in quantitative analysis. Useful 
pipettes may be made from straight glass tubing. 




116 



APPARATUS AND REAGENTS. 



Urinometers. I have found many of the 
urinometers on the market very inaccurate. The 
best instrument is the one sup- 
plied by Dr. E. E. Squibb of 
Brooklyn (Fig. 17). It is of 
the most approved shape — with 
the air chamber ovoid instead 
of cylindrical — and each instru- 
ment has been tested, and its 
variations at 1000, 1030 and 
1060 noted. It is standardized 
for a temperature of 77° F. 
(25° C), a temperature much 
more easily obtainable than 60° 
F. The glass cylinder has a 
heavy foot, and its sides are 





Fig. 16. 
Volume Pipettes. 

fluted or indented. 
This form of cylinder 
and the shape of the 
urinometer air cham- 
ber prevent adhesion 
between the two. A 
thermometer accompa- 
nies the instrument. 

The specific grav- 
ity bead is very COn- Fig. 17. Specific Gravity Bead (5) 

vement lor either bed- 




and Dr. Squibb's Urinometer. 



side or office use. The bead in Dr. Oliver's test 
case has a density of 1008, and is sold with a 



APPARATUS AND REAGENTS. 



117 



graduated test tube for diluting the urine. It is 
quite accurate and convenient. A bead of a 
density of 1005 is, I think, to be preferred. 
Dr. A. B. Lyons, in the Pharmaceutical Rec- 





ord, 

1885. 



© 
© 



Fig. 18. Bead 
Urinometer. 

July 15, 

describes a 
very convenient 
and durable uri- 
nometer made 
with a set of spe- 
cific gravity 
beads. The in- 
strument (Fig. 18) 
consists of six 
beads arranged in 

Fig. 19. Mohr's Burette. n -, ° , , 

regular order, the 
heaviest at the bottom, in a narrow test tube, 
perforated at the bottom and closed with a nicked 
cork. 



118 APPARATUS AND REAGENTS. 

Burettes. Two Mohr's burettes (Fig. 19) of a 
capacity of 50 cc. are necessary in accurate quan- 
titative work. A burette holder is also essential. 

Graduated Jars. One with a capacity of 
2000 cc. for collecting and measuring the 24 
hours' urine. Smaller graduated cylinders of a 
capacity of 100 or 200 cc. 

Glass Funnels, three, assorted sizes. 

Beaker Glass es, one-half dozen. 

Porcelain Capsules, three. 

Spirit Lamp, stirring rods, wash-bottle, blow- 
pipe, platinum foil, swabs for cleaning test tubes, 
retort stand, red and blue litmus paper, filter 
paper, and a microscope with accessories. 

The apparatus necessary for emergency and 
bedside testing is conveniently put up in small 
compact cases, to be carried in the pocket or 
medicine case. 

Reagents. General reagents. Acetic 
acid, nitric acid, hydrochloric acid, sulphuric 
acid, all chemically pure. 

Fuming nitric acid. 

Liquor potassae, U. S. P. Specific gravity 
1065. 

Liquor ammoniae, U. S. P. 

The magnesian fluid. 

Magnesium sulphate, 1 part. 
Ammonium chloride, 1 part. 
Solution of ammonia, 1 part. 
Distilled water, 8 parts. 

Solution of barium chloride. 

Barium chloride, 4 parts. 
Distilled water, 16 parts. 
Hydrochloric acid, 1 part. 



APPARATUS AND REAGENTS. 119 

Solution of copper sulphate. 

Copper sulphate, 1 part. 
Distilled water, 32 parts. 

Solution of silver nitrate. 

Silver nitrate, 1 part, 
Distilled water, 8 parts. 

Solution of neutral lead acetate. 

Neutral lead acetate, 1 part. 
Distilled water, 4 parts. 

Distilled water. 

Alcohol, ether, and chloroform. 

Special reagents for albumin testing. 

Potassio-mercuric iodide. (Tanret's reagent.) 

Potassium iodide, 3 32 grams. 
Mercuric chloride, 1.35 grams. 
Distilled water, 64. cc. 
Acetic acid, 20 cc. 

Solution of potassium ferrocyanide. 

Potassium ferrocyanide, 1 part. 
Distilled water, 4 parts. 

Solution of picric acid. 

Picric acid, 7 grains. 
Distilled water, 1 ounce. 
Dissolve by boiling and filter. 

Solution of sodium tungstate with citric acid. 

Solution sodium tungstate (1 to 4), 1 part. 
Solution citric acid (10 to 6), 1 part. 

Solution of acidulated brine. 

Saturated solution sodium chloride, 16 parts. 
Hydrochloric acid, 1 part. 

Solution of phosphor-tungstic acid. 

Boiling saturated solution of sodium tungstate. 

Phosphoric acid to acid reaction. 
Cool and make strongly acid with acetic acid. 
Let stand for 24 hours and filter. 



120 APPARATUS AND REAGENTS. 

Special reagents for glucose testing. 

Fehling's solution. 

Copper sulphate, 34.64 grains (534.6 gr.). 
Rochelle salt, 173.0 grams (6 oz. av.) 
Sodium hydrate, 40. grams (617.3 gr.). 
Water to make 1 litre (33.82 fl. oz.). 
1 cc. (mxv)=.005 (gr. y^) glucose. 

Fehling's solution in two solutions. 

(1) Copper sulphate, 69.28 grams (505.9 gr.) 
Sulphuric acid, 1 cc (8 m.). 

Water to make 1 litre (1 pint). 

(2) Rochelle salt, 350 grams (6 oz av.). 
Sodium hydrate, 100 grams (730 gr.). 
Water to make 1 litre (1 pint). 

These solutions mixed in equal volumes reproduce Feh- 
ling's solution. 

Prof. Wayne's formula with glycerin. 

Copper sulphate, 80 grains. 
Caustic potassa, 15 grains. 
Pnre glycerin, 2 fl. drams. 
Water, 6 fl. oz. 

Pavy's solution. 

Copper sulphate, cryst. 4.158 grams. 
Rochelle salt, recryst. 20 400 grams. 
Caustic potassa, 20.400 grams. 
Strongs ammonia (sp. gr. 0.880) 300 cc. 
Water to make 1 litre. 
1 cc.=.0005 glucose. 

Indigo-carmine is best used in tablet or test 
paper, as the quantity of the reagent and sodium 
carbonate must be always the same. 

Special reagent for bile-salt testing. 
Dr. Oliver's peptone test. 

Pulverized peptone (Savory and Moore), gr. xxx. 
Salicylic acid , gr. iv. 
Acetic acid (B. P.) mxxx. 
Distilled water to make "% viii. 
Filter until transparent. 



APPARATUS AND REAGENTS. 121 

The nitric magnesian test. 
Pure nitric acid, 1 part. 

Saturated solution magnesium sulphate, 5 parts. 
Filter till perfectly clear. 

Miscellaneous reagents. Bismuth sub-ni- 
trate, solution of ferric chloride, potassium bro- 
mide, potassium iodide, tincture guaiac, ozonized 
ether (solution of hydrogen peroxide in ether). 

Tablets and Test Papers. 

Dr. Geo. Oliver, of London, introduced to the 
profession a few years ago reagents put up in the 
form of test papers. They consist of strips of 
bibulous paper saturated with a reagent and 
dried. When used the reagent is dissolved out 
and the paper removed from the test tube. This 
form of reagent is exceedingly convenient, and 
makes bedside urine testing practicable. They 
have the advantage also in containing always the 
same quantity of reagent. This is of considera- 
ble value in albumin testing, and absolutely ne- 
cessary in testing for glucose by indigo-carmine. 

For a few months I have been experimenting 
with reagents in the form of tablet triturates, 
manufactured at Dr. A. B. Lyons' suggestion by 
Parke, Davis & Co. 

The results have been highly satisfactory. In 
this form the reagent is quickly and completely 
soluble, and does not leave after solution a paper 
to be extracted or fibres to make the solution 
turbid. It has all the advantages of the paper 
and none of its objections. 

Tablets or papers are as useful for office as for 
bedside testing. They are permanent, compact 
and cleanly, and all the reagents used in ordinary 
testing may be embodied in them. 



122 APPARATUS AND REAGENTS. 

The reagents that are put up in this form are — 

Indigo-carmine ; 

Potassio-mercuric iodide ; 

Potassium ferroeyanide ; 

Picric acid ; 

Sodium tungstate ; 

Citric acid ; 

Sodium carbonate ; 

Oliver's peptone test. 
Tablets with the apparatus for bedside testing 
are put up in small pocket cases, very convenient 
and compact, by Messrs. D. O. Haynes & Co. 






ADDENDA 



1. Nitric MEagnesian Test for Albu- 
min. Dr. H. B. Millard, of New York, speaks 
very highly of a modification of the nitric acid 
test introduced lately by Dr. Roberts. He terms 
it the nitric magnesian test. The reagent con- 
sists of a mixture of nitric acid, one volume, 
with a cold saturated solution of magnesium 
sulphate, five volumes. (See page 121.) Pour 
30 minims (2 cc.) of the reagent into a test tube, 
carefully overlay this with 60 minims (4 cc.) of 
the urine. If albumin is present a white ring 
forms at the plane of contact of the two fluids. 
• The advantages of this reagent over pure 
nitric acid are : 1st. It is not corrosive, and 
does not stain the fingers, or produce a colora- 
tion with itfdides. 2d. Its great density makes 
the reaction an exceedingly sharp one, so that 
the test has even greater delicacy than where 
pure nitric acid is used. 

Dr. Millard regards this as the most satisfac- 
tory test for albumin as regards delicacy, accu- 
racy and facility of employment. Its indications 
are the same as those of the nitric acid test 
(page 57). 

2. Estimation of Uric Acid. *Hay- 

crqftfs Volumetric Method. ■ Principle. Urate 
of silver is soluble in nitric acid, but insoluble 
in ammonia. 

* This method, recently published, is the most exact yet devised. 



124 ADDENDA. 

Solutions required — 

(1) Ammoniacal solution of silver nitrate. 
Silver nitrate, 5 grams. 

Water, 90 cc. 

Ammonia sufficient to make a clear solu- 
lution, and water to make 100 cc. 

(2) Ammonium sulpho-cyanide centinormal. 
Ammonium sulpho-cyanide, 8 grams. 
Distilled water, 1 litre. 

Adjust strength to centinormal silver 

nitrate. 
1 cc. == 0.00168 gram uric acid. 

(3) Saturated solution of ferric alum as an 

indicator. 
Process. To 25 cc. of urine, freed from albu- 
min, add 1 gram sodium bicarbonate and 2.5 cc. 
water of ammonia. Then add 1 to 2 cc. of the 
silver solution, collect the precipitate, wash with 
distilled water until the washings are free from 
silver, dissolve in a little dilute nitric acid, and 
estimate the silver in the solution by titration 
with the sulpho-cyanide solution, using the ferric 
alum as an indicator. Multiply the number of 
cc. used by .000642 (.00168 -^ 25 X 10) and 
divide the specific gravity of the specimen to 
obtain the uric acid. Or, multiply the number 
of cc. used by .00306 to find the number of 
grains of uric acid in each fluid ounce of urine. 



POCKET 



Urine Test Case 



APPARATUS AND REAGENTS 

COMPLETE, 

For Carrying out ml Tests at tie Bedside or in tli 



ESPECIALLY PREPARED UNDER THE DIRECTION OF DR. 
JENNINGS, FOR WORKING FROM HIS "PRAC- 
TICAL URINE TESTING. 11 



THE CASE CONTAINS: 

Graduated Tubes, Pipette, Specific Gravity 
Apparatus, Litmus Paper, and the nec- 
essary Reagents in the latest 
improved form of Tablets. 



PRICE, $2,09, Complete, with Eztra Supply of Tablets, 

SENT POST-PAID ON RECEIPT OF PRICE. 



We will also undertake to supply at reasonable rates the special 
pieces of Chemical Apparatus recommended by Dr. Jennings. 

D. O. HAYNES & COMPANY, 

21 State Street, 

DETROIT, - MICHIGAN. 



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